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OTAS exhibits adequate construct validity as assessed by consistency in the scoring by expert versus novices-ie, expert raters produce significantly more consistent scoring than novice raters. Further validation should assess the learning curve for novices in OTAS. Relationships between OTAS, measures of technical skill, and behavioral responses to surgical crises should also be quantified.

Background Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit. Objective To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit. Design/Methods A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed. Results The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time. Conclusions Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients.Clinical handover between shift changes is a necessary process to ensure seamless continuity of patient care. However, deficiencies in the handover process can introduce error. The accurate transfer of a necessary amount of clinical information to allow the continuation of safe care and, in addition, bring fresh intelligence to clinical problems, requires an efficient, clear and comprehensive system of communication.Despite awareness that handover systems were inadequate as long ago as 1996 in the UK, 1 it has taken several years for action to be taken, prompting the production of guidelines for handover. 2Despite the large number of handover studies conducted in the past two decades ( We wished to improve the morning handover round on our 21-bed Neurosciences Critical Care Unit (NCCU), a busy unit with a bed occupancy rate of approximately 90%, caring for neurosurgical/neurology and general patients requiring intensive care. Our specific aim was to improve the quality of the whole process. We felt that a goodquality handover would use the most appropriate setting, where the environment enhanced information transfer in addition to maximising the time utilised so that pertinent and complete clinical information was presented and discussed without unnecessary ...