Abstract
Importance: Communication failures during patient transitions remain a leading cause of sentinel events, medical errors, and treatment delays. In perioperative settings, particularly between anesthesia providers and PACU (Post anesthesia care unit) nurses, ineffective handoffs increase the risk of adverse events. Structured communication frameworks such as SBAR (Situation, Background, Assessment, Recommendation) have been shown to improve information clarity and handoff consistency.
Objective: To enhance anesthesia-to-PACU handoff communication and assess the effectiveness of a structured SBAR training intervention in improving provider knowledge, attitudes, and the overall quality of handoff practices.
Design, Setting, and Participants: This quality improvement project used a pre- and post-intervention design guided by The Model for Improvement, and Plan-Do-Study-Act (PDSA) cycles at a large academic teaching hospital in the southeastern United States. A convenience sample of 22 PACU nurses and 11 anesthesia providers participated. Participants completed pre- and post-intervention surveys and were observed during 21 handoffs before and 12 handoffs after the intervention.
Main Outcome and Measures: Outcomes were assessed using two validated tools: the KA-SBAR instrument, measuring provider knowledge and attitudes, and the Handoff Clinical Evaluation Exercise (Handoff-CEX), evaluating handoff quality across domains such as communication, organization, and clinical judgment.
Results: Thirty-three participants completed the pre-intervention survey and 23 completed the post-intervention survey. Most (67%) were PACU nurses, and nearly half had over 10 years of experience. While KA-SBAR scores showed no significant change (knowledge: p = 0.339; attitude: p = 0.701), baseline scores were already high (PACU nurses: Mean = 44/48 Anesthesia providers: Mean = 39/48). In contrast, Handoff-CEX scores demonstrated statistically significant improvements in provider-rated domains, including communication skills (p = 0.003), content (p < 0.001), and overall competence (p = 0.002). Recipient ratings also improved in clinical judgment (p < 0.001), professionalism (p = 0.002), and communication (p = 0.002), though not in setting or organization.
Conclusion: Structured SBAR training, peer coaching, and real-time feedback improved observed handoff communication between anesthesia providers and PACU nurses. High baseline knowledge limited measurable change in attitudes, but observed behavior improved meaningfully. Continued role-specific education, environmental support, and routine observation are essential to sustain gains and enhance patient safety during perioperative handoffs.