Nancy Threefoot, Fairview Southdale Hospital, Minnesota

Handoff Communication in Critical Care
Can the use of Insitu simulation improve
communication and patient safety?
Fairview Southdale Hospital
Edina, Minnesota
Intensive Care Unit &
Operating Room
The Objectives for this presentation
• Review Team STEPPS communication
• Describe Team STEPPS in this project
• Define Insitu simulation
• Describe how Insitu simulation was used
• Identify communication gaps in patient hand off
• Describe the research project
“Public speaking is the art of diluting a two-minute idea
with a two-hour vocabulary.” (JFK)
In 2008 our hospital adopted a
Team STEPPS initiative.
What is Team STEPPS?
Goal is to develop highly skilled teams in order to
improve patient outcomes
How does this apply to our project?
According to Team STEPPS (2006),
hand off communication conveys information,
transfers authority and responsibility during
transitions in patient care.
• According to Joint Commission a “sentinel
event is an unexpected occurrence involving
death or serious physical or psychological
injury, or the risk thereof”.
“The single biggest problem in
communication is the illusion that it has
taken place”
George Bernard Shaw
What is insitu simulation?
Training approach
Uses a human patient simulator (Sim Man)
Conducted in patient care unit
(Miller, 2008)
Why Insitu Simulation?
• Mistakes
• Teams work
• Simulatiion
(Miller, et al, 2008).
The purpose of our Insitu project was to examine
communication skills between the OR and the
Intensive Care Unit teams during the critical
hand off of a cardiovascular surgical patient.
Using the OR and ICU teams:
• Sim Man as a fresh post op CV surgical patient.
• Critical event requiring staff to react and communicate.
• Immediately as the team members came together for
the transition of care.
• Our observations-communication during this transition.
This is what we found!
Barriers to effective communication
Random, chaotic and inconsistent.
Communication is a patient safety issue.
What we found out.
The outcome of this project revealed that more
work is needed to improve communication
between the two teams.
The Design of the Research Project Includes:
• Filming a scripted scenario.
• Education
• Ongoing evaluation of communication
between the teams
Experience after simulation-one of our
ICU nurses
When all other means of communication
fails, try words
Agency for Healthcare Research and Quality (AHRQ). (2006) Team
Malec, J., et al (2007). The mayo high performance teamwork scale:
Reliability and validity for evaluating key crew resource management
skills. Simulation in healthcare. 2(1), pp. 4-10.
Miller, K., et al (2008).In situ simulation; A method of experiential learning
to promote safety and team behavior. Journal of perinatal neonatal
nurse 22(2), pp.105-113.

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