The Handoff Process

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Intraoperative handoffs of anesthesia care to other providers are commonplace whether it’s for breaks or at shift change. While there’s no “correct” way to do this, I’ve outlined the approach I take.

  1. Provide a brief background history as well as pertinent exam and lab findings. If the patient has blood products ordered/pending, I mention that (especially antibody status for type and screens).
  2. My most important step is the “left-to-right” survey. Starting from the left side of the patient, I’ll sweep to the right and mention every monitor (nerve stimulator, BIS monitor, BP cuff, pulse oximeter, Bair Hugger, OG tube, temperature probe, etc.), line (peripheral IV, central line, arterial line, Foley), and anything else which may be hanging (fluid bags, infusions)

    Where the magic happens!
  3. Active issues – I’ll mention things I’ve been struggling with throughout the case (hypertension, hypoxemia, etc.), how I’ve been dealing with it, and things which have and have not worked. Some examples I’ve recently dealt with include having to bolus albumin and intermittent vasopressors for hypotension, having to start a Cardene infusion for hypertension, more frequent administration of muscle relaxant than usual, and high peak pressures responsive to endotracheal tube suctioning. This saves the new provider a lot of time in troubleshooting problems and finding efficacious solutions.
  4. I make sure all the drugs I pushed (especially narcotics), procedure notes, and other case information are all accurately documented. I’ll also mention how the patient was pre-operatively (anxious, calm, altered) and the goals for post-op disposition (PACU, ICU, step-down).

Typically, a thorough handoff at the end of a shift takes me ~2 minutes and hopefully leaves with the incoming provider with a sense of how the case has been going so far and issues he or she may need to deal with.

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