Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety.

Abstract

OBJECTIVES:

To examine quality and safety in inter-professional clinical handovers in Post Anaesthetic Care Units (PACUs) and make recommendations for tools to standardize handover processes.

DESIGN:

Mixed methods combining data from observations and focus groups.

SETTING:

Three PACUs, one public tertiary hospital and two private hospitals.

PARTICIPANTS:

Observations were made of 185 patient handovers from anaesthetists to nurses. Eight focus groups were conducted with 62 staff (15 anaesthetists and 47 nurses) across the study sites.

INTERVENTION:

Inter-professional clinical handovers in PACU's.

MAIN OUTCOME MEASURES:

Characteristics of the structure and processes that support safe inter-professional PACU handover practice.

RESULTS:

Characteristics of the process, content, activities and risks during anaesthetist to nurse patient handover into the PACU were integrated into four steps in the PACU handover process summarized by the acronym COLD (Connect, Observe, Listen and Delegate), a verbal communication tool (ISoBAR), a checklist of critical information for safe patient transfer into PACU and a matrix of factors perceived to increase handover risk.

CONCLUSIONS:

The standard structure and checklists for optimal content of patient handovers were derived from existing practices and consensus, hence, expected to provide ecologically valid and practical resources to improve quality and safety during clinical handovers in the PACU.