Abstract
Background
Patient handover continues to be an international health priority in the prevention
of patient harm. Transitioning patients from the intensive care unit (ICU) to the
ward is complex, particularly for trauma patients, due to the multifaceted aspects
of their care requirements as a result of multiple injuries and different speciality
teams.
Objectives/aim
To design, implement, and evaluate the efficacy of a standardised handover process
and tool for the transfer of ICU trauma patients.
Methods
A multimethod before/after study design was used. This included observations before
and after an implemented transfer process and semistructured interviews with ICU and
ward nurses caring for trauma patients. Comparisons were made of data before and after
the intervention.
Results
Eleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from
the ward) were interviewed. Patients and family members were included during the handover
following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were
asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in
patient observations handed over were reported following the intervention. However,
omissions remained in some key areas including patient introduction, patient identity,
fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that
the new handover process was perceived advantageous by both ICU and ward nurses because
of its structured and comprehensive approach. Identified future improvements included
the need for hospital service managers to ensure integration of ICU and ward electronic
health record systems.
Conclusion
Precise, accurate, and complete handover remains a patient safety concern. Improvements
were achieved using a standardised process and handover tool for the transfer of complex
trauma patients. Further improvements are required to reduce the failure to hand over
essential patient information.
Keywords
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Article info
Publication history
Published online: January 06, 2023
Accepted:
October 31,
2022
Received in revised form:
October 25,
2022
Received:
August 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.