ICU/OR/Anesthesia Collaborative on Streamline Patient Care Hand Overs
between OR / ICU
Purpose: The purpose of this communiqué is to enhance communications
between ICU, AIP OR Nurses and Anesthesia during hand-off of patient care.
Goal: The goal of effective communication would be to optimize patient care and
safety, as well as to improve ICU/Perioperative Services /Anesthesia working
relationships and
An understanding would exist that:
 There will be times when emergent cases, difficult cases, and / or staffing
issues can make any of the discussed ICU goals difficult to achieve.
 The ICU teams and OR Teams (Anesthesia Provider and OR Nurse)
teams will work together for best patient care, along with smooth patient
flow by whatever means necessary.
 If any of the guidelines designed here are unable to be met due to unusual
circumstances, this is acceptable provided clear explanation and open
communication occurs between team members.
Patients arriving to Pre Op from ICU
Scheduled or add on cases
 Patients in the ICU setting should be transferred to Pre Op prior to the
surgery at the discretion of the Intensive Care Charge Nurse in
collaboration with the Pre Op Charge Nurse.
 Intensive Care Unit patients who are floor or step down status, in addition
to ICU level non ventilated, with or without telemetry would be examples of
patients appropriate for ICU to Pre Op transfer prior to OR.
 The Pre Op Charge Nurse will contact the ICU Charge Nurse via phone to
discuss the appropriateness of patient for the Pre Op Area to accept care
for.
 If in agreement, the Pre Op Nurse will contact the ICU nurse caring for the
patient to receive report, and work out logistics for transport of patient to
the Pre Op unit.
 If patient is not appropriate for Pre Op the ICU Charge nurse will contact
the OR Charge nurse and communicate this.
Patients arriving to the OR from an ICU
Scheduled cases or add on cases
 When time of case start has been established OR Charge Nurse, or
designee will contact the applicable ICU unit via phone and provide the
ICU Charge RN the scheduled time which will be given to the nurse caring
for the patient. The ICU Charge Nurse will also contact the Anesthesia
Tech at 85912, and request a transport monitor be brought to the unit so
the ICU nurse can proceed with getting the patient ready for transfer.
 The ICU RN will begin preparation of the patient for surgery, completing
the pre op checklist within the electronic medical record.
ICU / Anesthesia Communication Guideline
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Anesthesia Provider will contact the ICU RN prior to sending for the
patient to receive a report of pertinent patient information.
o This report should include patient status, infusions including rates,
ventilatory status, and other pertinent patient information.
o Agreement should exist on what equipment is relevant to patient
care in the OR. Some equipment may be left in the ICU.
o In certain circumstances, such as surgical cases involving Burn
patients, the exchange of pertinent patient information may be
merely an update from the previous OR procedure with the ICU RN
conveying pertinent changes and information to the Anesthesia
Provider.
o The ICU RN transporting the patient will carry a phone during
transport.
Coordination for transport, including Respiratory Therapy, should be done
prior to transport time.
When the Anesthesia Provider and OR Nurse are ready to accept the
patient, a member of that team will contact the ICU and request the patient
be brought to the OR meeting the OR team at the door designated at the
time of the call.
At the time of hand over, any changes in patient condition since the initial
report to the Anesthesia team will be provided by the ICU RN.
In the event the OR Team is not at the door waiting, the hand over of the
patient, the ICU Nurse will contact the OR Charge Nurse at 83512
Patients arriving to PACU from the OR prior to transferring to ICU
Patients will be recovered in PACU prior to being transferred to ICU unless
otherwise coordinated by the OR and ICU Charge Nurse
Prior to leaving the OR
 The OR Nurse will ensure PACU is called by the OR Team an hour prior
to leaving the OR when possible, thus ensuring:
o Accurate report given to RN prior to transfer ICU staff available and
room ready
 Report from the OR Team to PACU should include:
o Identification of person calling report and receiving report
o Pertinent clinical information – including procedure, hemodynamic
status, lines and infusions, ventilatory status, height and weight and
other significant information
o Estimated time of arrival
o A call from the OR when the patient is leaving and an update of
any changes.
o The OR Team (OR Nurse and Anesthesia Provider) will transfer the
patient to PACU.
o At the discretion of the Anesthesiologist the patient may be
transferred from the OR directly to ICU.
ICU / Anesthesia Communication Guideline
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If an unexpected delay occurs due to change in patient condition, the Circulating
Nurse will contact the PACU Charge Nurse.
Patients arriving to an ICU from the OR:
Prior to leaving the OR
 The OR Nurse will ensure that the ICU is called by the OR Team an hour
prior to leaving the OR when possible, thus ensuring:
o Accurate report given to RN prior to transfer to the ICU
o ICU staff available and room ready
o RT available with appropriate equipment
o ICU physicians aware of arriving patient
 Report from the OR Team to the ICU Nurse should include:
o Identification of person calling report and receiving report
o Pertinent clinical information – including procedure, hemodynamic
status, lines and infusions, ventilatory status, height and weight and
other significant information
o Estimated time of arrival
o A call from the OR when the patient is leaving and an update of
any changes.
o The OR Team (OR Nurse and Anesthesia Provider) will transfer the
patient to the ICU.
If an unexpected delay occurs due to change in patient condition, the Circulating
Nurse will contact the ICU Charge Nurse.
Upon arrival to the ICU
 The goal is for an expedient and thorough handover report:
o Identify and provide report to primary nurse immediately upon
arrival to ICU while other team members settle patient
o Initial monitor to be switched to the ICU monitor should be the
arterial line if there is one.
o Update patient picture for the ICU team
o Safe, thorough and complete report should be achieved within 10
minutes to allow the Anesthesia team to complete case, computer
charting, and prepare for next case, as well as allowing care to be
assumed by ICU team.
 Bedside Reconciliation
o Medications initiated in the OR will be labeled with patient ID
sticker, drug name, and concentration.
o The weight will be programmed in the pump based on the best
available information for each patient, and should be included in
hand over reports.
o If there is any reason that the full information is not able to be
clearly labeled in the OR due to patient’s complexity of their care,
this can be reconciled as part of the hand off communication
between the Anesthesia provider and the ICU RN on arrival in the
ICU.
ICU / Anesthesia Communication Guideline
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o All medications in syringes should be removed from IV tubing by
the Anesthesia provider prior to leaving unit
o Any questions by either team can be voiced at this time and
resolved.
Anticipated changes in hemodynamics or status
o The Anesthesia Provider will inform the ICU team in the hand over
report of a suggested plan for patients who are not yet
hemodynamically stable following a case, including most recent
interventions.
o If there is an anticipated change in hemodynamics as a result of an
intervention prior to arriving in the ICU and this change should be
communicated to the ICU RN as part of hand over communication.
Once ICU Nurse and Anesthesia Provider agree that a thorough
understanding exists related to this patient, the Anesthesia Provider will
relinquish the patient to the ICU teams.