Skip to main content

Safer ICU trainee handover: a service improvement project


Quality handover between team members within the ICU is vital for patient safety. Critically ill patients are at high risk of medical errors; these complex patients are exposed to high-risk interventions, medical and procedural [1]. Distractions are known to be particularly prevalent within critical care [2]. This can compromise handover efficiency, interrupt information-giving and may ultimately lead to poorer patient outcomes [3]. We sought to demonstrate the capability of junior physicians to lead change to their practices that benefit the quality of patient care in a large critical care unit. We present an improvement project that has transformed handover quality in our ICU.


Participant observation of handover practices took place within a high-occupancy 33-bed adult ICU. Quantitative assessment of handover criteria as per Royal College of Anaesthetists guidelines [4] was performed at baseline (handovers: n = 6, patients: n = 119) and 3 months post-intervention (handovers: n = 4, patients: n = 108). Interventions included presentation of data at multiprofessional departmental meetings, education of team members regarding frequency of handover interruptions and development and utilisation of an electronic handover tool.


Provision of patient details during handover was substandard. Utilisation of a structured handover sheet significantly improved the number of patient details provided; in particular, patient age (18% vs. 100%), duration of stay (29% vs. 79%) and medical management plan (53% vs. 93%). Frequent handover interruptions seen on initial observation significantly improved (100% vs. 25% of handover periods interrupted) following our collaboration with the senior nurse, physiotherapist and other team leads regarding the number and nonurgent nature of interruptions; at re-audit, interruptions occurred for clinically urgent requests only.


Simple measures instituted by junior doctors, such as team education and use of a structured handover tool, can aid high-quality handover within critical care. Evidence suggests that high-quality handover within critical care will translate into improved clinical care for patients.


  1. 1.

    Reader TW, et al.: Curr Opin Crit Care. 2007, 13: 732-736. 10.1097/MCC.0b013e3282f1bb0e

    Article  PubMed  Google Scholar 

  2. 2.

    Horn J, et al.: Anaesthesia. 2004, 59: 658-663. 10.1111/j.1365-2044.2004.03760.x

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Nimmo G, et al.: JICS. 2008, 9: 240-242.

    Google Scholar 

  4. 4.

    McQuillan P, et al.:The Royal College of Anaesthetists. Raising the Standard: A Compendium of Audit Recipes. 2nd edition. 2006, 218-219. []

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to E Godfrey.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Godfrey, E., Hassan, I., Carson-Stevens, A. et al. Safer ICU trainee handover: a service improvement project. Crit Care 16, P518 (2012).

Download citation

  • Published:

  • DOI:


  • Critical Care
  • Junior Doctor
  • Improvement Project
  • Critical Care Unit
  • Poor Patient Outcome