{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T21:12:56Z","timestamp":1783977176657,"version":"3.55.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n To reduce care failures by 30% through implementation of standardized communication processes for postoperative handoff in NICU patients undergoing surgery over 12 months and sustained over 6 months.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Nineteen Children\u2019s Hospitals Neonatal Consortium centers collaborated in a quality improvement initiative to reduce postoperative care failures in a surgical neonatal setting by decreasing respiratory care failures and all other communication failures. Evidence-based clinical practice recommendations and a collaborative framework supported local teams\u2019 implementation of standardized postoperative handoff communication. Process measures included compliance with center-defined handoff staff presence, use of center-defined handoff tool, and the proportion of handoffs with interruptions. Participant handoff satisfaction was the balancing measure. Baseline data were collected for 8 months, followed by a 12-month action phase and 7-month sustain phase.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n On average, 181 postoperative handoffs per month were monitored across sites, and 320 respondents per month assessed the handoff process. Communication failures specific to respiratory care decreased by 73.2% (8.2% to 4.6% and with a second special cause signal to 2.2%). All other communication care failures decreased by 49.4% (17% to 8.6%). Eighty-four percent of participants reported high satisfaction. Compliance with use of the handoff tool and required staff attendance increased whereas interruptions decreased over the project time line.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Team engagement within a quality improvement framework had a positive impact on the perioperative handoff process for high-risk surgical neonates. We improved care as demonstrated by a decrease in postoperative care failures while maintaining high provider satisfaction.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2020-016402","type":"journal-article","created":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:17:02Z","timestamp":1637713022000},"source":"Crossref","is-referenced-by-count":13,"title":["STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs"],"prefix":"10.1542","volume":"148","author":[{"given":"Anthony J.","family":"Piazza","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Emory University and Children\u2019s Healthcare of Atlanta at Egleston, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Brozanski","sequence":"additional","affiliation":[{"name":"School of Medicine, Washington University and St Louis Children\u2019s Hospital, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Grover","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chuo","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Mingrone","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Soliman","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Children\u2019s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Rintoul","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby","family":"Bellflower","sequence":"additional","affiliation":[{"name":"Le Bonheur Children's Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Richardson","sequence":"additional","affiliation":[{"name":"Children's Hospital Association, Overland Park, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Holston","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"McClead","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Guidash","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Health System, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia K","family":"Pallotto","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, School of Medicine, University of Missouri-Kansas City and Children's Mercy Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"issue":"4","key":"2021121010404747800_B1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1136\/qshc.2007.024570","article-title":"Improving measurement in clinical handover","volume":"18","author":"Jeffcott","year":"2009","journal-title":"Qual Saf Health Care"},{"issue":"2","key":"2021121010404747800_B2","first-page":"52","article-title":"Patient handoffs: standardized and reliable measurement tools remain elusive","volume":"36","author":"Patterson","year":"2010","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"19","key":"2021121010404747800_B3","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1056\/NEJMsa1405556","article-title":"Changes in medical errors after implementation of a handoff program","volume":"371","author":"Starmer","year":"2014","journal-title":"N Engl J Med"},{"key":"2021121010404747800_B4","unstructured":"The Joint Commission Center for Transforming Healthcare\n . Hand-off communication. Available at: https:\/\/www.centerfortransforminghealthcare.org\/improvement-topics\/hand-off-communications\/#1e05ae4f664643d49010a5c91bb4330b_a88932916d0a492ca8abd7af10801d1d. Accessed February 28, 2020"},{"issue":"2","key":"2021121010404747800_B5","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/00001888-200402000-00019","article-title":"Communication failures: an insidious contributor to medical mishaps","volume":"79","author":"Sutcliffe","year":"2004","journal-title":"Acad Med"},{"issue":"6","key":"2021121010404747800_B6","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1067\/msy.2003.169","article-title":"Analysis of errors reported by surgeons at three teaching hospitals","volume":"133","author":"Gawande","year":"2003","journal-title":"Surgery"},{"issue":"7","key":"2021121010404747800_B7","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1097\/CCM.0b013e3182514bab","article-title":"Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance","volume":"40","author":"Agarwal","year":"2012","journal-title":"Crit Care Med"},{"key":"2021121010404747800_B8","article-title":"Using six sigma methodology to improve handoff communication in high-risk patients","volume-title":"Advances in patient safety: new directions and alternative approaches (Vol. 3: performance and tools)","author":"Mistry","year":"2008"},{"issue":"3","key":"2021121010404747800_B9","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/PCC.0b013e3181fe25a1","article-title":"Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit","volume":"12","author":"Joy","year":"2011","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"2021121010404747800_B10","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/PCC.0000000000000343","article-title":"Standardizing postoperative PICU handovers improves handover metrics and patient outcomes","volume":"16","author":"Breuer","year":"2015","journal-title":"Pediatr Crit Care Med"},{"issue":"8","key":"2021121010404747800_B11","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1097\/ACM.0b013e31825cfa69","article-title":"The effects of patient handoff characteristics on subsequent care: a systematic review and areas for future research","volume":"87","author":"Foster","year":"2012","journal-title":"Acad Med"},{"issue":"21","key":"2021121010404747800_B12","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1001\/jama.2013.281961","article-title":"Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle","volume":"310","author":"Starmer","year":"2013","journal-title":"JAMA"},{"issue":"8","key":"2021121010404747800_B13","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1038\/jp.2014.26","article-title":"The Children\u2019s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care","volume":"34","author":"Murthy","year":"2014","journal-title":"J Perinatol"},{"issue":"3","key":"2021121010404747800_B14","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1542\/peds.2012-1999","article-title":"Levels of neonatal care","volume":"130","author":"American Academy of Pediatrics Committee on Fetus And Newborn","year":"2012","journal-title":"Pediatrics"},{"issue":"4","key":"2021121010404747800_B15","doi-asserted-by":"crossref","first-page":"e20191121","DOI":"10.1542\/peds.2019-1121","article-title":"STEPP IN: Working together to keep infants warm in the perioperative period","volume":"145","author":"Brozanski","year":"2020","journal-title":"Pediatrics"},{"key":"2021121010404747800_B16","unstructured":"AGREE Next Steps Consortium\n . The AGREE II instrument. Available at: www.agreetrust.org. Accessed February 28, 2020"},{"issue":"4","key":"2021121010404747800_B17","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jopan.2007.05.010","article-title":"Improving patient safety by implementing a standardized and consistent approach to handoff communication","volume":"22","author":"Sandlin","year":"2007","journal-title":"J Perianesth Nurs"},{"issue":"1","key":"2021121010404747800_B18","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1213\/ANE.0b013e318253af4b","article-title":"Can we make postoperative patient handovers safer? A systematic review of the literature","volume":"115","author":"Segall","year":"2012","journal-title":"Anesth Analg"},{"issue":"2","key":"2021121010404747800_B19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/JPN.0000000000000102","article-title":"Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units","volume":"29","author":"Grover","year":"2015","journal-title":"J Perinat Neonatal Nurs"},{"issue":"1","key":"2021121010404747800_B20","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-3642","article-title":"SLUG Bug: quality improvement with orchestrated testing leads to NICU CLABSI reduction","volume":"137","author":"Piazza","year":"2016","journal-title":"Pediatrics"},{"issue":"4","key":"2021121010404747800_B21","doi-asserted-by":"crossref","first-page":"e20163178","DOI":"10.1542\/peds.2016-3178","article-title":"Sustaining SLUG bug CLABSI reduction: does sterile tubing change technique really work?","volume":"140","author":"Pallotto","year":"2017","journal-title":"Pediatrics"},{"key":"2021121010404747800_B22","unstructured":"Institute for Healthcare Improvement\n . The breakthrough series: IHI's collaborative model for achieving breakthrough improvement. Available at: www.ihi.org\/resources\/Pages\/IHIWhitePapers\/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx. Accessed February 28, 2020"},{"issue":"3","key":"2021121010404747800_B23","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1945-1474.2010.00106.x","article-title":"Balancing cost and precision in hospital accountability sampling","volume":"33","author":"Perla","year":"2011","journal-title":"J Healthc Qual"},{"issue":"4","key":"2021121010404747800_B24","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jamcollsurg.2007.01.010","article-title":"Patterns of communication breakdowns resulting in injury to surgical patients","volume":"204","author":"Greenberg","year":"2007","journal-title":"J Am Coll Surg"},{"issue":"6","key":"2021121010404747800_B25","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1542\/peds.113.6.1609","article-title":"Voluntary anonymous reporting of medical errors for neonatal intensive care","volume":"113","author":"Suresh","year":"2004","journal-title":"Pediatrics"},{"key":"2021121010404747800_B26","volume-title":"The Health Care Data Guide: Learning From Data for Improvement","author":"Provost","year":"2011"},{"issue":"5","key":"2021121010404747800_B27","doi-asserted-by":"crossref","first-page":"352","DOI":"10.7326\/0003-4819-142-5-200503010-00010","article-title":"Fumbled handoffs: one dropped ball after another","volume":"142","author":"Gandhi","year":"2005","journal-title":"Ann Intern Med"},{"issue":"6","key":"2021121010404747800_B28","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1136\/bmjqs-2013-002341","article-title":"Interactive questioning in critical care during handovers: A transcript analysis of communication behaviours by physicians, nurses and nurse practitioners","volume":"23","author":"Rayo1","year":"2014","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"2021121010404747800_B29","doi-asserted-by":"crossref","first-page":"e20150166","DOI":"10.1542\/peds.2015-0166","article-title":"Changes in efficiency and safety culture after integration of an I-PASS-supported handoff process","volume":"137","author":"Sheth","year":"2016","journal-title":"Pediatrics"},{"issue":"13","key":"2021121010404747800_B30","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/jama.2015.12470","article-title":"Facilitating quality improvement: pushing the pendulum back toward process measures","volume":"314","author":"Bilimoria","year":"2015","journal-title":"JAMA"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-016402\/1210795\/peds_2020016402.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-016402\/1210795\/peds_2020016402.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T23:28:12Z","timestamp":1639178892000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/148\/6\/e2020016402\/183430\/STEPP-IN-A-Multicenter-Quality-Improvement"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,1]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,12,1]]},"published-print":{"date-parts":[[2021,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2020-016402","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,1]]},"article-number":"e2020016402"}}