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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].

References

  1. 1.

    Cohen MD, Hilligoss B, Kajdacsy-Balla Amaral AC: A handoff is not a telegram: an understanding of the patient is co-constructed. Crit Care 2012, 16: 303. 10.1186/cc10536

  2. 2.

    Ilan R, Lebaron CD, Christianson MK, Heyland DK, Day A, Cohen MD: Handover patterns: an observational study of critical care physicians. BMC Health Serv Res 2012, 12: 11. 10.1186/1472-6963-12-11

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    Frost P, Wise M: Resident consultants in large intensive care units? Crit Care Resusc 2006, 8: 50-51.

  4. 4.

    Richmond C, Merrick E, Green T, Dinh M, Iedema R: Bedside review of patient care in an emergency department: the cow round. Emerg Med Australas 2011, 23: 600-605. 10.1111/j.1742-6723.2011.01440.x

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Correspondence to Matt P Wise.

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Competing interests

The authors declare that they have no competing interests.

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Wise, M.P., Morgan, M.P., Hingston, C.D. et al. Bedside handover of critically ill patients. Crit Care 16, 419 (2012). https://doi.org/10.1186/cc11245

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Keywords

  • Emergency Medicine
  • Experienced Clinician
  • Critical Care
  • Communication Scheme
  • Physiological Variable