Bedside handover of critically ill patients

Cohen and colleagues' recent viewpoint emphasised that handover is not a unilateral transfer of information and that when poorly conducted it can degrade quality of care [1]. A key feature of handover required by clinicians is the big picture, which shapes the viewpoint of the receiving party [1]. Frequently this is obscured in critically ill patients by a surfeit of physiological variables or results, and this 'noise' denigrates the handover process. Such a scenario is often observed with less experienced clinicians, who are also the most frequently studied group. Only one investigation has described handover by experienced full-time faculty physicians in critical care [2]. Unsurprisingly, handover between these individuals did not conform to widely promoted communication schemes but did commonly include questions allowing two physicians to jointly construct a picture of the patient.

Our institution operates a unique staffing model for the United Kingdom, with a resident senior clinician (consultant) shift pattern [3]. Handover is performed on 19 occasions throughout the week (three times on week-days and twice daily at weekends) and is undertaken by the senior clinician. In contrast to how handover is performed in most institutions [2], this occurs at the bedside twice daily. Although not without challenges (including respecting the patient's dignity), performing handover at the bedside has several advantages - which include promoting a two-way dialogue between handover provider and recipient, and, most importantly, a visual reference of the patient between individuals participating in the transfer of care. This model of handover was also found to be more effective in other emergency settings [4].