Speakers
Melanie Meersch-Dini, MD
Professor
Department of Anesthesiology, Intensive Care and Pain Medicine
University Hospital Münster, Germany
Keywords
HandiCAP Trial, Pragmatic Clinical Trial
Key Points
- There is an increasing frequency of surgical procedures and the need for anesthesia care, and the number of care transitions is increasing. The HandiCAP trial asked the question do intraoperative handovers of anesthesia care have an impact on patient outcomes?
- The trial included adults 18 and older, ASA physical status III or IV, who had a major inpatient surgery with an anticipated duration of 2 hours or longer. Patients were registered and randomized centrally in a 1:1 ratio to receive either a handover of anesthesia care or no handover.
- In Germany, there are two levels of anesthesia, in-room anesthesiologists who are either trainees or a medical specialist (non-management). Then there is an attending anesthesiologist who is a supervisor responsible for 3-4 ORs.
- The primary endpoint was a composite of all-cause of death, readmission to hospital or major postoperative complications within 30 days. The secondary endpoints were individual criteria of the primary endpoint, hospital length of stay and ICU length of stay. The trial randomized 1,817 patients, with 908 randomized to the handover group and 909 to the no handover group.
- There was no significant different in the primary endpoint between the handover and no handover groups, and none of the composites were a significant difference. We performed a multivariable regression analysis for the primary endpoint and none of the factors were significantly different between the two groups. Short-term outcomes, surgery length of time, and level of training of the anesthesiologist were also not different between the two groups.
- There are some limitations and remaining questions from the trial: The trial did not include weekend and nighttime surgeries, so one remaining question is are handovers harmful during off-hours when fatigue and stress may play a bigger role? What affect does the experience of the surgeons and anesthesia and surgical nurses have on outcomes? Are the results generalizable to all patient cohorts and to other health care systems?
Learn more about the HandiCAP Trial.
Discussion Themes
-What instructions or guidance did you provide for the handover? We left them to their daily routine that they perform. We told them what they needed to tell the new anesthesiologist but not how to do the handoff.
–What didn’t go as you expected and what were some of the lessons that you learned that would inform a follow-on trial to this trial? We planned this trial with three centers and then the third center did not get the approval by the ethics committee, so we had to include 12 centers. The COVID situation was another aspect we could not control. We had to the change the protocol once to correct a wording mistake. What I learned from designing this trial is that you can never plan that centers will recruit the same amount of patients as we would do in the initiating center. You have to include more centers to reach your goal during the course of the study.
Tags
#pctGR, @Collaboratory1