Date of Award

2016

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Susan D. Newman

Second Advisor

Gayenell S. Magwood

Third Advisor

Martina Mueller

Abstract

Purpose: The purpose of this dissertation research was to study postoperative handover information transfers (PITS) and to ultimately improve patient safety and patient outcomes. One of the goals was to identify deficits in PITS by exploring information needs and processes related to PITS. Grounded by the social ecological model (SEM), a scoping review of extant literature was conducted to identify individual, interpersonal, organizational environmental and organizational policy level factors that influence the quality and processes of post-operative information transfers (PITS). An integrative review of extant literature was conducted to describe how PITS have been studied and to describe instruments that have been developed to improve PITS. Using participatory action research, a sequential mixed-methods study was undertaken to assess the feasibility of and pilot test the electronic post-operative information transfer instrument (EPITI). Problem: PITS have been described as fraught with errors and prone to information omissions (Catchpole, Sellers, Goldman, McCulloch, & Hignett, 2010; Segall et al., 2012, 2012). Information transfers between anesthesia providers and post anesthesia care unit nurses take place among a myriad of other patient care activities including re-establishing monitoring technology while communicating the verbal report (Smith, Pope, Goodwin, & Mort, 2008). Deficits in PITS have been associated with delays in medical treatment, and increased morbidity and mortality (Nagpal et al., 2013; Rose & Newman, 2016; van der Walt & Joubern, 2014). Previous research has shown that standardization of PITS increases the amount of information transferred (Potestio, Mottla, Kelley, & DeGroot, 2015; Salzwedel et al., 2013; Siddiqui et al., 2012) One way PITS have been standardized is by including post-operative information transfer forms within anesthesia information management systems (AIMS). Research is needed to assess the feasibility of implementing AIMS, including the EPITI by gaining insight from key stakeholders, defined as anesthesia providers (AP) and PACU nurses. Additional research is needed that describes the development, implementation and evaluation of electronic PIT instruments. The purposes of the manuscripts included in this dissertation were: Manuscript I Scoping Review: To identify factors at each level of the Social Ecological Model that influence PITS Manuscript II Integrative Review: To describe and synthesize instruments developed to improve PITS and to describe how PITS have been studied Manuscript III Pilot and Feasibility Study: To report on pilot testing and evaluation of the feasibility of the electronic post-operative information transfer instrument (EPITI) Design: Sequential mixed methods using a participatory action approach Findings: Individual, interpersonal, organizational and environmental factors influence PITS. Efforts including standardization of PITS have been undertaken to decrease information omissions and to improve interpersonal communication. After pilot testing the EPITI, results of qualitative and quantitative data analysis showed the EPITI was feasible, acceptable and integrated well into clinical practice when pilot tested by AP and PACU nurses. Conclusion: Additional research is needed to implement and assess the effect of electronic postoperative handover instruments on patient specific outcomes.

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