Handover checklists post cardio-thoracic surgery-are they useful?

Abstract

AB Introduction: Handover has become one of the most important clinical safety topics when considering patient continuity of care. Several studies have shown that poor handover results in an increase in adverse events, poor patient satisfaction and increased litigation. Objectives: The aim of the audit was to explore the effects of a newly written postsurgical cardiothoracic handover checklist. Specifically, would it improve the quality of handover, documentation and satisfaction amongst nursing and medical staff in a private 15 bedded Intensive Care Unit (ICU). Method: A new handover checklist was developed which included essential information for handover from all patients from cardiothoracic theatre to ICU. Prior to distribution, a fifth year medical student was present in an observational capacity during all daytime handovers for a two week period, Student observations and clinician checklists were then cross-referenced and compared, specifically focusing on knowledge gained and the need for prompting for additional information. The process of auditing the forms was non-blinded, with staff aware that they were being observed. An anonymous survey was then distributed to nursing and medical staff to gauge whether satisfaction and quality of handover had improved with the new, revised checklist. Post feedback an amended checklist was released and the observation process repeated. Results: Nineteen cardiothoracic handovers were observed. The new checklist increased the total information handed over by 31% and total omissions of criteria were reduced by 43%. Prompting for information doubled with use of the checklist. In the anonymous survey results, critical care nursing staff felt there had been an improvement in handover since the introduction of the new checklist. Conclusions: The new handover checklists increased the information communicated, doubled the prompting of information and increased critical care nurse satisfaction in the cardiothoracic theatre to ICU handover process.