Potential uses of AI for perioperative nursing handoffs: a qualitative study

ABSTRACT Objective Situational awareness and anticipatory guidance for nurses receiving a patient after surgery are key to patient safety. Little work has defined the role of artificial intelligence (AI) to support these functions during nursing handoff communication or patient assessment. We used interviews and direct observations to better understand how AI could work in this context. Materials and Methods 58 handoffs were observed of patients entering and leaving the post- anesthesia care unit at a single center. 11 nurses participated in semi-structured interviews. Mixed inductive-deductive thematic analysis extracted major themes and subthemes around roles for AI supporting postoperative nursing. Results Four themes emerged from the interviews: (1) Nurse understanding of patient condition guides care decisions, (2) Handoffs are important to nurse situational awareness; problem focus and information transfer may be improved by AI, (3) AI may augment nurse care decision making and team communication, (4) User experience and information overload are likely barriers to using AI. Key subthemes included that AI-identified problems would be discussed at handoff and team communications, that AI-estimated elevated risks would trigger patient re- evaluation, and that AI-identified important data may be a valuable addition to nursing assessment. Discussion and Conclusion Most research on postoperative handoff communication relies on structured checklists. Our results suggest that properly designed AI tools might facilitate postoperative handoff communication for nurses by identifying elevated risks faced by a specific patient, triggering discussion on those topics. LAY SUMMARY Nurses caring for patients after surgery make many decisions about what complications to look for and how to treat issues that arise. They rely on handoffs from prior providers to understand the patient’s background, events, and plans so far. We observed nurse handoffs after surgery where operating room nurses transfer information and their care responsibility to postoperative unit nurses to ensure care continuity. We also interviewed nurses to ask if and how artificial intelligence (AI) might help them focus their handoff communication on likely problems and generally understand the patient. Our participants stated that if AI identified likely issues, they would discuss those topics in handoff, communicate about those problems with physicians, and modify their monitoring and treatment to the level of risk faced by the patient. This finding runs against most research on improving communication, which focuses on checklists of topics to discuss. Most uses of AI for nurses focus on making specific to-do recommendations and documentation reminders and search, but we find that nurses would benefit from AI which focuses more on their understanding of the patient’s condition. These findings have major implications for the application of AI support for nurses.