Planning and Development Process
The Surgical Intraoperative Handoff Initiative was developed through the collaboration of OR leadership, OR quality improvement team, and frontline stakeholders, including current scrub personnel who provide relief to colleagues during breaks. Stakeholder meetings were held and initial audits were conducted to obtain baseline data. Working with stakeholders, all critical elements of the handoff between scrub personnel were identified and structured within a simple, memorable acronym. A SHRIMPS visual cognitive aid was developed to ensure discussion of critical information in each handoff (sharps/sponges on the field, hidden/held items, replaced items, instrument needs/items on the Mayo stand/implants, medications on the table/medications already administered, point in procedure with anatomy orientation, specimens collected/to be collected).
Resources Used and Skills Needed
SHRIMPS is listed on the VHA’s Diffusion Marketplace and was a winning innovation in the 2023 VHA Shark Tank competition, being named as a promising practice. The listing can be found on the Diffusion Marketplace.
Staff
To implement SHRIMPS handoffs, a scrub personnel champion was needed to lead and educate staff, report metrics during staff meetings, and to gather feedback from these important stakeholders during SHRIMPS implementation. An auditor was also needed to be engaged, either the OR nurse circulators who are already in the room or a dedicated quality improvement team member.
Costs and Funding Sources
The SHRIMPS visual cognitive aid was printed, laminated, and affixed to the OR wall in a convenient location for scrub personnel. Ideally this would be located near where the back table was set up to minimize disruption during cases and allow ease of access to this tool. No funding was utilized for implementation at our institution. Resources needed include access to a printer and staff with time to collect and analyze audit data.
What Were the Results?
Overall Results and Analysis
In the initial Plan-Do-Study-Act (PDSA) cycle, piloted in urology, general surgery, and neurosurgery, 100% of the 15 observed cases included handoff, averaging 76 seconds per handoff. Additionally, 100% of cases announced a handoff to the surgeon, and all elements were addressed 99.6% of the time. PDSA cycle 2 involved implementation to all service lines. Of the 68 cases observed, 100% included handoff, averaging 69.4 seconds per handoff, with 98.2% of elements addressed. Announcements of handoffs to the entire OR team were done 97.1% of the time, ensuring all staff were aware of personnel changes.
Setbacks
Engagement and involvement of stakeholders, with relevant staff including surgical technologists, OR nurse circulators, surgical leadership, and other members of the operative team, is critical to ensure successful implementation of this practice. Inherent to all quality improvement work, this first involved stakeholder meetings to achieve buy in from frontline staff, and continuous engagement with staff to receive feedback regarding institution-specific barriers to implementation. We were fortunate to have buy in and support form frontline stakeholders, surgical leadership, and the executive leadership team at our institution which is largely why this was so successful at the Lexington VA Medical Center. Design and implementation of SHRIMPS involved multiple Plan-Do-Study-Act (PDSA) cycles to refine this practice. One change which occurred during implementation was the addition of “Surgeon aware” to the first S of the SHRIMPS mnemonic after audits revealed this element to be missing frequently during SHRIMPS handoffs.
Tips for Others
How to Sustain the Activity
Topline and frontline OR stakeholders, surgical technicians, and circulating nurses were engaged with the QI team. This approached help with buy-in from the people using the tool.
Lessons Learned
The introduction of a standardized handoff protocol substantially improved communication among OR staff, ensuring critical information was transferred consistently.
Enhanced communication reduced potential patient safety risks and highlighted the importance of standardized handoff tools in improving surgical outcomes.
Future Plans
The success of the SHRIMPS protocol highlights the significant impact quality improvement programs can have in health care—by implementing standardized handoff protocols, operating rooms can achieve better communication, fewer errors, and enhanced patient care. Study authors advocate for the widespread adoption of such tools to ensure reliable and efficient information transfer in surgical environments.
