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SHRIMPS Surgical Intraoperative Handoff Initiative: Standardization of Scrub Personnel Handoffs
Share PrintThe Surgical Intraoperative Handoff Initiative was developed to standardize critical information to be conveyed during scrub personnel staff changes in the operating room during surgical cases. Through collaboration with key frontline stakeholders, OR leadership, and the quality improvement team, we developed a handoff tool and visual cognitive aid using the acronym SHRIMPS, which reminds surgical technicians of the critical elements to be performed in each handoff. Prior to implementation, handoffs occurred in 83% of cases. Targeted items discussed were highly variable, 30% to 78%. Implementation of SHRIMPS cognitive aid resulted in 100% performance of handoffs during surgical tech staff changes with 100% of targeted elements addressed, achieved in an average of 77 seconds.
Origin:
September 2022, Troy Bowling Campus (Lexington Cooper)
Adoptions:
1 successful, 1 in-progress
Awards and Recognition:
Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Surgery
Recent Updates
Overview
Problem
Communication within the operating room is critical for patient safety, avoidance of adverse events, and team cohesiveness; however, standardization of communication during scrub personnel handoffs does not exist.
Solution
The Surgical Intraoperative Handoff Initiative was developed through the collaboration of OR leadership, OR quality improvement team, and frontline stakeholders, including current scrub technologists and circulators who scrub to relieve scrub personnel. The purpose of the tool is to create a standardized list of critical information necessary to handoff duri
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The Surgical Intraoperative Handoff Initiative was developed through the collaboration of OR leadership, OR quality improvement team, and frontline stakeholders, including current scrub technologists and circulators who scrub to relieve scrub personnel. The purpose of the tool is to create a standardized list of critical information necessary to handoff during intraoperative surgical technician staff changes. 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).
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Results
Implementation of SHRIMPS visual cognitive aid allowed for improved integrity of scrub personnel handoff and communication in the OR during staff changes. Twenty-three cases were observed pre-implementation. Handoffs occurred in 83% of cases pre-intervention, of which only 42% included communication with the surgeon, and the elements of the handoff varied. S
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Implementation of SHRIMPS visual cognitive aid allowed for improved integrity of scrub personnel handoff and communication in the OR during staff changes. Twenty-three cases were observed pre-implementation. Handoffs occurred in 83% of cases pre-intervention, of which only 42% included communication with the surgeon, and the elements of the handoff varied. Sharps were discussed in 78%, instrument needs in 61%, medications in 65%, specimens requiring collection in 39%, and hidden items in 30% of handoff communications. In the initial Plan-Do-Study-Act (PDSA) cycle, piloted and audited in urology, general surgery, and neurosurgery after implementation of the standardized handoff, 100% of the 15 observed cases had a handoff performed, 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 35 cases observed, a handoff was performed in 100% of cases, announced to the surgeon in 97% of cases, and 100% of elements addressed in each case. The handoffs averaged 77 seconds.
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Images
SHRIMPS Pre and Post data
SHRIMPS Bar Graph
Metrics
- Implementation of SHRIMPS visual cognitive aid resulted in improved scrub personnel handoff, with handoff occurring in 100% of cases observed with 100% of elements addressed, at an average handoff time of 77 seconds. The visual cognitive aid consisted of a laminated letter-sized piece of paper, one placed in a convenient location near surgical tech station on the wall of each OR, achieved at little cost to the hospital.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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1 week
Obtain pre-data: collect audits of scrub personnel handoff, documenting the date, service line, when handoff occurred (lunch, post-lunch, shift change, etc), who initiated the handoff (exiting or relieving tech, other), time to handoff (in seconds), did handoff occur, was it announced, was it good timing during the case, and what was included (should include elements of SHRIMPS acronym. S: sharps on field, sponges on/in field, additional items; H: hidden items, held items; R: replaced/new items, opened/dropped items; I: anticipated instrument needs, instruments on mayo, implants discussed; M: meds on table, meds administered; P: point in the procedure, orientation to anatomy; S: specimens collected on table, specimens to be collected) -
1 hour
Create SHRIMPS visual cognitive aid (see supporting images/documents) -
4 hours
Hang SHRIMPS visual cognitive aids in every OR at a convenient place on wall for scrub personnel (near common work area) -
1 day
Educate OR staff during team meeting regarding implementation of the project: should include the expectations that handoff occur during every staff change and should include SHRIMPS elements, shift change and handoff occurrence should be announced so OR team is aware of shift change, should occur during an appropriate time during the case -
4 weeks
Collect data after implementation of visual cognitive aid (same measures as above)
Departments
- Cardiovascular surgery
- Colon and rectal surgery
- Colon and rectal surgery
- Dental/oral surgery
- Adaptive sports
- Neurosurgery
- Outpatient surgery
- Plastic and reconstructive surgery
- Surgery
- Surgical oncology
- Thoracic surgery
- Transplant surgery
- Vascular surgery
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Files
- This is a tabloid-sized poster of the “Scrub Personnel Report Tool” with vertically oriented “SHRIMPS” acronym in red lettering, spelling out the meaning of each letter to its right. The acronym stands for Sharps, sponges or other countable items on the field, Hidden or held items, Replaced, added or changed countable items, Instruments and implants, Medications, Procedure overview, and Specimens SHRIMPS Visual Cognitive Aid
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Difficulty standardizing the scrub personnel handoff | Utilize visual cognitive aid with SHRIMPS acronym, replicate this process with every handoff, provide education to staff |
| Efficiency of handoff | Utilize acronym to streamline important elements of handoff |
| Avoidance of case interruptions | Provide education with surgical technicians regarding cues for appropriate vs poor timing during cases for staff changes (eg complex or critical steps during a surgery, at opening or closing of a case, during an intraoperative complication, actively trying to control bleeding) |
| Finding an ideal location on the wall to hang visual cognitive aid | Talk with frontline stakeholders, scrub personnel, and ask where the best location for them would be |
| Difficulty creating visual cognitive aid | Discuss with your local VA learning resources center about making a colored, letter size printout and laminating it for placement in the operating room |
| Clutter with other visual cognitive aids in the OR | Evaluate the OR wall space and discuss with OR leadership regarding best way to implement this system |
About
Origin story
A staff member and current surgical technician approached our OR QI team with concerns regarding the lack of defined communication required during surgical technician handoffs. Audits of handoffs prior to intervention were performed, confirming lack of standardized information shared during handoffs and even lack of handoff in some scenarios.
Original team
Wesley Stephens, MD
Chief Resident in Quality and Improvement, data input and analysis, author
Andrew Harris, MD
Team leader for quality improvement, Chief of Surgery, project oversight
Sherry Lantz, RN
OR Nurse Manager, responsible for distributing and collecting audit sheets, communication with OR staff
Madeline Anderson, DO
Chief Resident in Quality and Improvement, continuation of audit review and data collection/analysis
Comment
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