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. 2017 Mar/Apr;32(2):186-193.
doi: 10.1177/1062860615617238. Epub 2016 Jul 9.

Handoffs in the Intensive Care Unit

Beth R Hochman  1 , Mark E Barry  1 , Meghan B Lane-Fall  1   2 , Steven R Allen  1 , Daniel N Holena  1   2 , Brian P Smith  1 , Lewis J Kaplan  1 , Jose L Pascual  1
Affiliations

Handoffs in the Intensive Care Unit

Beth R Hochman et al. Am J Med Qual. 2017 Mar/Apr.

Abstract

Operating room (OR) to intensive care unit (ICU) handoffs are complex and known to be associated with adverse events and patient harm. The authors hypothesized that handoff quality diminishes during nights/weekends and that bedside handoff practices are similar between ICUs of the same health system. Bedside OR-to-ICU handoffs were directly observed in 2 surgical ICUs with different patient volumes. Handoff quality measures were compared within the ICUs on weekdays versus nights/weekends as well as between the high- and moderate-volume ICUs. In the high-volume ICU, transmitter delivery scores were significantly better during off hours, while other measures were not different. High-volume ICU scores were consistently better than those in the moderate-volume ICU. Bedside handoff practices are not worse during off hours and may be better in ICUs used to a higher patient volume. Specific handoff protocols merit evaluation and training to ensure consistent practices in different ICU models and at different times.

Keywords: handoff; sign-out; transition in care; weekend effect.

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Conflict of interest statement

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
ICU1 OR-to-ICU handoffs on weekdays versus nights/weekends. Comparison of handoff metrics in high-volume ICU1 on weekdays versus nights/weekends. (A) Histograms indicate the proportion of handoffs in which a physician or advanced practitioner on the ICU team performed a physical examination of the patient (Physical Exam), and the proportion of handoffs rated satisfactory or better for teamwork, professionalism, and transmitter (surgeon or anesthesiologist) delivery. Error bars represent SEM. ** versus night and weekends. P < .01. (B) Histograms indicate the mean number of content items omitted from the handoff reports (Content Omit), total length of combined anesthesia and surgery reports (Length [minutes]), number of people in the room during the handoff (Number in Room), number of passive listening skills (maximum = 3) demonstrated by the provider receiving the handoff (Pass List), and number of active listening skills (maximum = 2) demonstrated by the provider receiving the handoff (Act List). For all values in the figure, higher scores are better, except for “Content Omit,” in which a lower score indicates better performance. Error bars represent SEM. Abbreviations: ICU, intensive care unit; OR. operating room; SEM, standard error of the mean.
Figure 2
Figure 2
ICU2 OR-to-ICU handoffs on weekdays versus weeknights. Comparison of handoff metrics in moderate-volume ICU2 on weekdays versus nights. Categories are the same as described in Figure 1. Abbreviations: ICU, intensive care unit; OR, operating room.
Figure 3
Figure 3
OR-to-ICU handoffs in ICU1 versus ICU2. Comparison of handoff metrics between high-volume ICU1 and moderate-volume ICU2. Categories are the same as described in Figure 1. *P < .05 versus ICU2, **P < .01 versus ICU2. Abbreviations: ICU, intensive care unit; OR, operating room.
See this image and copyright information in PMC

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