Transitioning a patient from the operating theatre (OT) to the intensive care unit
(ICU) is a dynamic and complex process. Handover of the critically ill postoperative
patient can contribute to procedural and communication errors. Standardised protocols
are means for structuring and improving handover content. Both have been shown to
be effective in reducing information omission and improve communication during this
The aim of this uncontrolled before and after study was to improve handover processes
and communication about the care for critically ill patients transferred from OT to
Thirty-two OT to ICU handovers (16 before and 16 after implementation) were observed.
Using a structured tool, we documented who was present, participated in, and initiated
handover during ICU admission. Where and when handover was performed, information
provided, distractions and interruptions, and handover duration were also recorded.
Unstructured field notes and diagrams provided information on staff interaction. Following
implementation, semistructured interviews with 27 participants were conducted to understand
participants' perceptions of intervention acceptability and to determine factors influencing
intervention implementation and spread.
Following implementation, a “hands-off” approach was observed with fewer technical
tasks completed during handover (43.8% before implementation vs 12.5% after implementation)
without an increase in handover time. A single, multidisciplinary handover most often
led by the anaesthetist was observed after implementation. Despite these improvements,
the use of the physical checklist was not observed in practice, and an situation,
background, assessment, recommendation (SBAR) format was not followed. Anaesthetists
leading the handover did not view the handover checklist as being beneficial to their
practice although some nurses were observed to use the checklist as a prompt for additional
A single, multidisciplinary handover demonstrated improvement in handover practice
despite low uptake of the protocol checklist. Further information is required to inform
targeted strategies to improve uptake and sustainability although broader interdisciplinary
engagement and commitment may be helpful.