OBJECTIVETo describe the characteristics and barriers in the handover process in a medical intensive care unit.DESIGNA cross-sectional descriptive study using a checklist to observe nurses and doctors during handover of patients in and out of the intensive care unit.SETTINGThe 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.PARTICIPANTSHandover 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 MEASURESThe 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.RESULTSThe 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.CONCLUSIONThe 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.

AIMS AND OBJECTIVESTo identify the differences in practices and perceptions of handovers between nurses and residents in the critical care setting, so as to improve the quality of the process.BACKGROUNDCritically ill patients with complex problems are ideal for the study of handovers. However, few handover studies have been conducted in intensive care units.DESIGNDescriptive study using questionnaires.METHODSWe interviewed all nurses and residents involved in handovers of patients admitted to and discharged from a medical intensive care unit over a period of one month. Interviews were guided by a questionnaire and conducted between 24-48 hours of handovers.RESULTSOut of 672 eligible participants, 580 (290 nurses and 290 residents) agreed to participate in the study (86·3% response rate). Compared to residents, nurses received more training on handovers, covered issues specific to allied health specialties more frequently during handovers, and reviewed patients earlier after handovers. The perceived importance of the different components of handover varied significantly: donor residents, donor nurses, recipient residents and recipient nurses emphasised the overall management plan, case complexity, management plan over the next 48 hours and past medical history, including allergies, respectively. Satisfaction in the handover was related to pre-handover review of electronic medical records, handover training and clarity level in the management plan following the handover, with only the last factor remaining significant on multivariate analysis.CONCLUSIONSMore nurses than residents received prior training in handovers. Nursing handovers were more inclusive of allied health specialties. The perceived importance of the components of handover varied. Greater clarity in management plans was associated with better satisfaction.RELEVANCE TO CLINICAL PRACTICEDeficiencies in the handover process (lack of prior training in handovers, not including allied health specialties and not reviewing electronic records before handover) were identified, thus providing opportunities for mutual learning between nurses and residents.

Handovers are often associated with poor communication. ICU patients with multiple complex problems are ideal to study naturally occurring handovers. However, few studies have been conducted in the ICU.