Date of Award

Fall 2022

Project Type


College or School




Program or Major

Direct Entry Master's in Nursing

Degree Name

Master of Science

First Advisor

Pamela Kallmerten



Background: Handoff communication is essential for patient safety, especially in the perioperative setting as a critical care environment. Preoperative communication between operating room nurses and preoperative room nurses was suboptimal in a local microsystem as evidenced by pre-intervention data collection where 82% of cases did not participate in handoff, 11% with partial adherence of policy and only 7% in full adherence. The global aim of this project was to improve the handoff communication between the preoperative nurse and operating room nurse in the surgical day center (SDC) within the chosen microsystem to promote patient safety and positive patient outcomes. The specific aim of this quality improvement project was to achieve 100% adherence with the facility handoff policy during the transition of care from surgical day center to the operating room by July 26, 2022.

Methods: To develop and pursue a quality improvement initiative in this setting, the Plan-Do-Study-Act framework was utilized. A 5P assessment was performed on the microsystem and preoperative communication was isolated as an important area to improve. As the facility’s

policy for handoff communication was already inclusive of best practice initiatives determined by literature review, educational materials were developed in order to promote adherence to the existing policy. Observation of this transition of care event also occurred both prior to and immediately following the distribution of materials. Staff surveys were also developed with the objective of determining the usefulness of the educational modules in the noted changes to adherence.

Intervention: A recorded, educational presentation on the current policy of handoff communication was distributed via email by the nurse educator for the microsystem.

Results: By July 14, 2022, post intervention data collection showed 52% of cases included handoff communication and 48%. However, other observations made during the time of data collection in addition to the few survey responses indicate that alternative factors may have contributed to the observed improvement.

Conclusion: Although improvement was observed which reflects the ability of the microsystem to alter their process to better reflect best practice, there is still an opportunity for improved handoff communication. Increased prioritization of proper handoff communication per agency policy is necessary for sufficient change. By continuing to alter and improve this process, the microsystem can further prioritize patient safety.