Observation of handover process in an intensive care unit (ICU): barriers and quality improvement strategy

Int J Qual Health Care. 2015 Apr;27(2):99-104. doi: 10.1093/intqhc/mzv002. Epub 2015 Feb 2.


Objective: To describe the characteristics and barriers in the handover process in a medical intensive care unit.

Design: A cross-sectional descriptive study using a checklist to observe nurses and doctors during handover of patients in and out of the intensive care unit.

Setting: The study was conducted at a 1000-bed tertiary hospital in Singapore. The unit admits all patients under university medicine clusters, except those needing cardiology services.

Participants: Handover between 90 pairs (180 participants)-50 nurse-to-nurse (100 nurses) and 40 doctor-to-doctor (80 doctors)--were passively observed in real time during morning and evening shifts over weekdays.

Main outcome measures: The number and types of distractions and their relationship to the time spent during handover, the information included during handover, and the number of working shifts.

Results: The results showed that there were 1.26 (± 1.75) distractions per handover. In 45 (50%) handovers, no distraction occurred. The human factor was the most common distracting factor during handovers, whereas short message service and monitor alarms were not identified as distracting factors. The information included least often was 'do not resuscitate' (DNR). Nurses spent significantly longer during handovers than doctors.

Conclusion: The findings provide information for improving the handover process during the transfer of patients in and out of the intensive care unit. Distractions during handovers are common and are associated with longer durations. Nurses and doctors rarely address DNR status during handover of ICU patients in this study.

Keywords: intensive care; quality improvement; quality management; setting of care.

MeSH terms

  • Attention
  • Clinical Alarms
  • Critical Care / methods
  • Critical Care Nursing / methods
  • Cross-Sectional Studies
  • Humans
  • Intensive Care Units* / standards
  • Patient Handoff* / standards
  • Physician-Nurse Relations
  • Quality Improvement*
  • Singapore
  • Time Factors