ICU handover: are we forgetting something? A preliminary study
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KeywordsFluid Balance Prospective Observational Study Infection Status Educational Experience Medical Comorbidities
The aim of this ongoing study is to review the process of handover in a university teaching hospital ICU, highlight areas of special interest and deficiency during the process, and improve current practice. Clinical handover, defined as a process of transferring authority and responsibility for providing care of patients from departing caregiver to named recipient, is a basic part of clinical practice. Failure to exchange essential information and focus on the important may have disastrous consequences for the patient.
A prospective observational study was undertaken over a 22-day period to examine the quality and content of clinical handover by nightshift doctor to the medical team. Key aspects expected to be handed over included patient details, diagnosis, system - treatment domains and communication with relatives. Additional data collected also included duration of handover and frequency of interruptions.
A total of 207 sets of patients were collected during the study period. All handovers were supervised by a consultant intensivist. Clinical information handed over verbally covered reason for admission in 12% of cases, working diagnosis in 13% and current management plan in 29% (100% in these three in new admissions). Medical comorbidities where also poorly covered (8%). The handover was rather focused on special aspects of clinical information like the respiratory system (86%), fluid balance and laboratory findings (68%), infections status (67%), CNS (56%) and hemodynamics (54%), while nutrition and GI was poorly covered (20%). Only 26% of handovers covered significant changes in the last shift, 21% commented on the interventions made and 32% had a proposed plan for the forthcoming day discussed. Of the allocated 30 minutes, the duration of the handover varied from 20 to 50 minutes (average 28 minutes). There was a total of 34 interruptions over 22 days of the audited period. Reasons for interruption included telephone calls and requests from visiting teams and nurses.
Our study identified that the structure of the handover was rather focused on a system-based approach. Difficulty in concentration due to fatigue or frequent interruptions prolongs its duration and disturbs the right flow of information. The senior clinician must ensure that handover should be a focused but educational experience for the trainee with appropriate feedback.
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