Differences in the handover process and perception between nurses and residents in a critical care setting.

Abstract

To 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. Critically ill patients with complex problems are ideal for the study of handovers. However, few handover studies have been conducted in intensive care units. Descriptive study using questionnaires. We 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 24-48hours of handovers. Out 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 48hours 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. More 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. Deficiencies 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.