Quality and safety of handover in intensive care

Abstract

IntroductionHandover is an inevitable and essential aspect of caring for critically ill patients and information handed over should be accurate, succinct, and sufficient to allow the seamless continuation of care between teams. Objectives To assess staff involvement, time taken for the handover, key components addressed, availability of a standard format and factors causing disturbances to an effective handover were the key components studied to determine the quality and safety. Methodology Study population were doctors and nursing offices working in the general and specialised ICUs of the National Hospital of Sri Lanka, De Soysa maternity hospital and the Castle street hospital for women. Study period was July to September 2013. Sample size was 120. Data was collected using a self-administered questionnaire based on the guidelines on clinical handover by the Australian Medical Association. Data was analysed as simple percentages and review of absolute numbers using bar and pie charts for each ICU. ResultsThe doctor's presence in the nurse's handover and nurse's presence in doctor's handover was less than 70% in all the ICUs. There was no fixed time for handover in 92% of ICU shifts and nearly 90% of times it happened after the conclusion of the shift and the average time taken was 30mins. Compliance with the recommended content of handover was more than 60% in almost all the ICUs. There was no structured format for handover in any of the ICUs. Telephone calls were the most common distracting factor identified. Conclusion / RecommendationsHandover can be made more effective and safe with implementation of a printed handover sheet for use as well as an overlapping shift pattern in duty rosters, dedicated time and a place for handover.

Obstetric shift-to-shift handover in Kerala, India: A cross-sectional mixed method study

“…In other LMICs, data are scarce for all types of shift-to-shift handovers and particularly for maternity care, but conclusions from the three studies we were aware of, were overall consistent with our findings [ 26 , 27 ]. In the Gambia, similar issues existed with no doctor handover, selective handover of some women and incomplete notes [ 33 ].…”

“…Investigation of clinical handover is important for ensuring high quality patient care, since evidence from high-income countries (HICs) and LMICs indicates that continuity of patient care and thus patient safety are compromised as the result of inadequate shift-to-shift handover [ 9 , 20 , 24 – 27 ].Other settings advocate the use of SBAR tools for conducting shift-handovers and this proved a useful tool for our assessment [ 28 – 32 ]. On application of an adapted SBAR assessment tool, the number of environment items with which each handover complied was similarly good in all settings.…”

“…In contrast to our study in India, high-risk women were more likely to be handed over and with more completed items, while the handover environment was less adequate than in our India study. In Sri Lanka, one study concerning intensive care units noted several issues with handover including no designated time for handover, not all doctors and nurses being present at handover, and a lack of a set structure for the format of handover [ 27 ]. Amongst the recommendations, the study suggested that having a printed handover format, a set time and location for handover would be beneficial to improve safety and effectiveness of handovers [ 27 ].…”

The current practice of clinical handover process in emergency departments in National Hospital, Kandy and University Teaching Hospital, Peradeniya: a descriptive cross-sectional study

“…A very careful handing over process could have a profound positive effect on better and safer patient care service provision [1]. The most important function is communicating information and transferring the responsibility and accountability from one healthcare professional to another [2]. Accurately transferring information assures safe transition of health care from one professional to the next [3].…”

“…The handing over process takes place at the bedside of the patient in between changing shifts with the participation of the outgoing doctor and the incoming doctor. In the Sri Lankan setting, the outgoing doctors provide the clinical information to the incoming doctor mostly by memorizing the facts, sometimes using Bed Head Ticket (BHT), and usually, the incoming doctor neither takes any notes during the process nor uses any information technology methodologies to store this information [1,2].…”