Handover in ICU - how do you do it?

Todd Fraser on 16-10-2012

Clinical handover is a hot topic in medicine.  Its been identified by multiple bodies, including the World Health Organisation, who listed it on their top 5 hit list to improve patient outcomes.

Its something we've been doing for years, so I suspect we barely give it a second thought.

But it seems there's almost as many variations as there are intensive care units.

Various recommendations for improving handover exist, including protecting handover time, face-to-face communication, assistance of electronic and written components, challenge-response formats, preparation for handover and multidisciplinary teams.  Each of these have their limitations and strengths, while there are constant barriers to effective handover, including urgent patient reviews, multiple telephone calls, and time and space pressures.

So how do you do it?  What things have you put in place to improve the quality of your handovers?


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Joanne wrote 10-17-2012 11:39:44 am
Nice topic.

We have a sit-down handover away from the bedside. Its multidisciplinary and there are a number of non-clinical medical staff around so there is often some conversation and teaching elements. We have a dedicated room with AV assistance so we can have pathology and radiology results on display. Overall, it works reasonably well.

One of the problems is the time issue - some of the handovers last over an hour.

Nate Maxwell wrote 10-22-2012 09:19:56 am
I think we need to change - my unit has been doing walk-around handover at the bedside for years. It frustrates the hell out of me - people get left behind, its hard to hear, the X-ray machine gets pushed through the middle of the round, there's no electronic support. Its a complete mash.

I think we need to go to a sit down handover format like Joanne's

Todd Fraser wrote 10-22-2012 09:24:14 am
Great comments guys. I agree with both of you, a sit down handover is much better. I once designed a very structured handover - a bit like MIST in trauma (Mechanism, Injury, Status and signs, Treatment). This worked quite well, keeping the handover to a regular pattern, and the registrars seemed to like it. The other thing I think is very important is to directly engage the allied and nursing staff in the handover, and I also find that closing the loop is important - repeating the handover summary back to the person giving it to make sure that you've got the story straight, particularly with new patients. This is really important, and requires a certain level of discipline to achieve.

Jackson Bird wrote 10-23-2012 11:11:11 am
I agree with the multiple team member approach. We've been getting the bedside nurse involved as well. It takes a bit of time and isn't always easy, but we pause while we wait for the nurse to come to the handover room too, so that he or she can be involved. Its interesting how often they make a contribution that alters the plan.

Meghan wrote 10-24-2012 10:36:21 am
I have to say I still like doing it at the bedside. I just get a better feel for the patient if I can "eye-ball" them.

The other question in all this is how you do your rounds. I like going from bed to bed as a group rather than splitting them up, but I am aware of other units who do the latter.

sid wrote 10-31-2012 01:06:45 pm
In our handover rounds( at the bedside), night team summarises overnight issues in a structured way- saves times and they go home, and then the detailed ward round proceeds which includes inputs from other teams etc. The consultant changeover handover which occurs once a week is more detailed one.

I have seen and done sitdown handovers- they tend to involve everyone and drags on for a while, go through every labs/radiology/fluid status etc which you would do anyway in your daily wardrounds.

Sitdown rounds, I feel are fine for micro or xray rounds but not for ICU handover

Jacko from Australia wrote 12-23-2012 10:05:46 am
I don't agree - sit down rounds allow a quiet environment that people can clearly hear, are not interrupted and can ask questions or clarify information. If they are structured and well led by a consultant who is practiced in doing them, they do not have to drag on. Also, putting info up on a screen is distracting, so should only be used when a clinical issue needs clarification.

Another important element is preparation. Too many registrars turn up without a clear plan of what they are going to say.

Its all about how its run.

Matbailey from 9012 wrote 01-22-2013 06:36:46 pm
We have a sit down multidiscplinary handover (including the patient nurse). I like it, but its a bit slow with the nurses coming in and out so woudln't work for a larger unit.
We have recently re-built our database so it includes the admission note and a "major event summary" (which the registrars like cause it makes writing a discharge easier)
The database generates a handover - all current patients' admission notes and all events. This is viewable online and from home. Many like this because it is a way the guy on the day before can communicate directly with the next day team (not via the night team) and because they can read and get a feel for the patients, then hear it soon after and reinforce/ ask pertinent questions at the handover. I used some of the OSSIE handover principles when trying to design this. (U Tas paper)
Seems to work well.

Drsushin from Brunei wrote 01-31-2013 11:24:03 pm
Nice to hear. Initially we had sit down handover including nurses in separate room.
Its too much time consuming and out of communication with other specialities come for rounds to make decision. Now we changed to bedside handover. We feel this works well for our ICU. So that we can glance at each patients and decide which patient needs urgent attention. And to communicate with other surgical specialities.




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