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By ISQua Monday. Mar 2, 2015

Observation of Handover Process in an Intensive Care Unit (ICU): Barriers and Quality Improvement Strategy

during the transfer process of patients in or out of a medical intensive care unit (MICU).We called this as transfer reports or handovers. The reasons were to determine what nurses and doctors did while doing the transfer report, and how they performed that transfer process.  Our team created an observation checklist and trained the team members to use this checklist as they observed the nurses and doctors.  

We observed 50 pairs of nurses reporting to each other, and 40 pairs of doctors reporting to each other during patient transfers.  The observations were completed between 8am-11pm on Monday to Friday.  The figure below represents the observation process.



After the observation, we found that the human factor (e.g. doctors, nurses, family members, and patients) was the most common distracting factor during transfer reporting. This was followed by phone calls, while short message service (SMS) and monitor alarms were not identified as distracting factors. Documentation and tools used while transfer reporting were checklists or report sheets, reading back, patient records (paper or digital), and other tools such as verbal checking or using a blank piece of paper. 

Patients’ records were used the most during handover, followed by checklists. The information included most often during reports were patients’ background, patients’ conditions, what had been done, abnormal findings, and what needs to be done regarding the abnormal findings. The information included least often was “do not resuscitate” (DNR) information. Patients’ concerns were emphasised less often than family issues and information. Nurses spent significantly longer during handovers than doctors.  The team’s findings provide information for improving the reporting process during the transfer of patients in and out of the intensive care unit (ICU). 

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