Professor Rick Iedema Director of the Centre for Health

Communication, UTS

Dr Robert Herkes, Director of Intensive Care Services RPA

Sydney

Eamon Merrick RN MHSM, Research Fellow

Centre for Health Communication, University of Technology

Sydney

Royal Prince Alfred Hospital Intensive Care Services, Sydney

South West Area Health Service
•  Objectives, participants will be able to:
–  View, from a different perspective, how handovers are
conducted in intensive care.
–  Discuss the functions of handover in a intensive care
service.
–  Reflect on the difficulties that can confront ‘good’ handover.
–  Articulate & Plan strategies for the improvement of
handovers.
•  Outcomes, participants will be able to:
–  Articulate the issues that confront effective handover in their
own clinical settings.
–  Discuss types of handover improvement strategies and how
these may be applied practically.
–  Communicate to their colleagues about contemporary
approaches to handover improvement and feel able to
implement these in their own clinical setting.
“ … the transfer of professional responsibility and
accountability for some or all aspects of care for a patient, or
group of patients, to another person or professional group on a
temporary or permanent basis”1.

“… to provide accurate information about a [patients] care,

treatment, services, current condition and any recent or
anticipated changes….. The information communication during
handoff must be accurate in order to meet [patient] safety
goals”2.

(1) Australian Medical Association. (2006). Safe Handover: Safe

Patients. Canberra: Australian Medical Association.

(2) The Joint Commission. (2007). Hospital/ Critical Access National

Patient Safety Goals.: The Joint Commission.
 180
A 24hr cross-sectional
160
observational study.
140

n= 205 ICUs, 1,913 120

adult patients. 100

80
584 Sentinel events
affecting 391 patients. 60

40

20

0
Medication Lines, catheters, Euip Fail Airway Alarms
drains

(3) Valentin, A., Capuzzo, M., Guidet, B., Moreno, R., Dolanski, L., Bauer,
P., et al. (2006). Patient Safety in Intensive Care: Results from the
multinational Sentinel Events Evaluation (SEE) study. Intensive Care
Medicine, 32, 1591-1598.
n=2966 root cause Pt. Assessment
analyses

Three leading factors

are: Orientation
1.  Communication
2.  Orientation
3.  Pt. Assessment
Communication

0 10 20 30 40 50 60 70

(4) http://www.jcaho.org/accredited+organizations/ambulatory+care/
sentinel+events/root+causes+of+sentinel+event.htm
In your groups discuss the challenges inherent in
maintaining accurate handover:

People involved in handover

skill levels, expertise, professional types
The types of information required by participants?
Where, who synthesizes this information?
Where, what, are potential sources of error?
How would you improve these situations?

C1
(4) Coiera, E., Jayasuriya, R. A., Hardy, J., Bannan, A., & Thorpe, E. C.
(2002). Communication loads on clinical staff in the emergency
department. Medical Journal of Australia, 176, 415-176.
•  Content standardisation
–  Listing of specific information that should always be
mentioned in a handover
•  Topic standardisation
–  Specification of general topic areas that should be
covered in handover
•  Process standardisation
–  The process that work groups develop/deployed for
the ongoing evaluation of handover performance
Understanding levels of clinical expertise
Understanding clinical roles
Understanding (intuitively) team dynamics
Skill mix
Organisational dynamics
Service dynamics
Understanding & synthesizing clinical need
•  Level of care uncertainty
•  (Non) standard time(s) for handover
•  (Variable) location where handover is conducted
•  (Different) participants in the handover (mono- vs
multi-disciplinary interaction)
•  (Different) informational needs of participants
•  (Changing) length of time devoted to handover
•  Spatial organisations and arrangements (where is
handover conducted?)
In your groups articulate a strategy to improve this handover:

Would you use content, topic, or process standardisation?

What would this strategy look like, describe the:
Planning
Implementation
Evaluation
How might you ensure local relevance?
How might you maintain buy in?

C2
 Content Standardisation

Topic Standardisation
•  Participation
•  Observation
•  Filming
•  Reflexive Sessions
•  Implementation
•  Ongoing self-evaluation
• Lack of clinical ‘ownership’ of patient care
(nursing)
• Planning of care inadequately implemented
due to lack of interdisciplinary communication
• Dangers of discontinuity of care
• Nurse led (facilitated by senior medical staff)
handovers at ward round
• Improved continuity of care
• Educational opportunities
• Clinical team building
• Communication is prone to interruptions
• Out-dated information
• Time intensive >45mins

• Handover at the patients bedside led by the

senior registrar
• Visual verification of information
• Precise
• Concise
• Professional format
• Time reduced <15-30, mins
• Opportunities for dialogic education
• Coordination between disciplines
• Availability of contemporaneous information
• Early insight into emerging, potential, or previously unrecognised
problems
• Opportunity for the negotiation of supervisory support

“We must be alert to all the functions of handoff activity”

•  Bedside patient check
•  Multi-disciplinary handover
•  Cross-hierarchy communication
•  Checklist support
•  Agreed interruption rules
•  Systematized documentation process