Safer ICU trainee handover: a service improvement project

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.