Neuro-anesthesia handover checklist.

Sir,

Anesthesia handover or transfer of anesthesia care is considered to be a risk factor for the patient safety if not delivered properly.[1] The basic component behind the compromise transfer of care is to miss the relevant information at the time of handover.[2] However, a significant reduction in morbidity and mortality has been reported after the implementation of checklist based handover.[3] In few of the morbidity meetings related to our neurosurgery cases, we found that they were directly linked to the problems associated with the handover of cases in between the shifts. Mostly the finishing time of the list is beyond 20:00 h, the reason due to which our patients have to face the sharing of anesthesia care. To overcome this problem we generated the Neuro-anesthesia handover checklist [Figure 1]. The checklist was developed after sharing it with the faculty members and getting the comments from all of them. Then, we displayed it by suspending the list on the anesthesia trolley in two operating rooms dedicated for neurosurgery cases [Figure 2]. All the faculty members including the residents were informed about it and requested to follow the handover pattern between the shifts. The checklist includes the information related to the preoperative status of the patient including comorbid conditions, presenting signs and symptoms, size and location of a particular tumor. This part also has the information related to any issue pertaining to the scheduling of the list. The second component of the checklist includes the intraoperative information linked to the induction of anesthesia, positioning, the type of monitoring instituted, analgesia given and the blood loss happened. The next component is the postoperative plan that is whether the extubation is planned, or patient is going to be shifted to intensive care for elective postoperative ventilation. We think that the handover should be very specific in terms of postoperative plan. The relevant information which plays an important role in the patient care, is to give the complete handover about the left over cases and or any issues in the laboratory reports, etc. The last aspect of the check list is the communication part with the primary team as well as the recovery or intensive care team. It includes the information about any intraoperative event, the definite postoperative plan, which includes the requirement of mean arterial pressure, seizure prophylaxis, and postoperative antibiotics. The list is not exhaustive, but we think that if one will follow this or modified it according to their setup, it will help in maintaining standardization of the handover in between the shifts. The tool is also very useful for the trainee anesthetists as they may develop critical thinking about the patient care and may act in advance about any issues that interfere in the smooth running of the theatre list. Though the document is in the form of checklist, but the main purpose is just to remind the faculty and juniors about the core points need to be considered at the time of handover.

Figure 1

Neuro-anesthesia handover check list

Figure 2

Check list hanging on the machine