Handover patterns: an observational study of critical care physicians

Abstract

BackgroundHandover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication.MethodsProspective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations); SOAP (Subjective, Objective, Assessment, Plan); and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics.ResultsMean (± standard deviation) duration of patient-specific handovers was 2 min 58 sec (± 57 sec). The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9%) of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0) times in patient handovers; they followed Objective blocks in only 45.9% of the opportunities and preceded Plan in just 21.8%. Certain communication elements were occasionally absent. For example, SBAR's Recommendation and admission note information about the patient's Past Medical History were absent from 22 (55.0%) and 20 (50.0%), respectively, of patient handovers.ConclusionsClinical handover practice of faculty-level critical care physicians did not conform to any of the three predefined structuring schemes. Further research is needed to examine whether alternative approaches to handover communication can be identified and to identify features of high-quality handover communication.

Are Attendings Different?. Intensivists Explain Their Handoff Ideals, Perceptions, and Practices

“…I've found a lot of people at Chuck-E-Cheese or they're going to lunch, it's a common time for children's birthday parties." (Intensivist 12) (14). The authors of this study videotaped 40 attending handovers, noting poor conformation of these handoffs to any of three common communication schemes: SBAR (Situation, Background, Assessment, Recommendation), SOAP (Subjective, Objective, Assessment, Plan), or the format of a standard medical admission note.…”

“…In contrast, transitions of care at the attending physician level have been less well studied (10)(11)(12)(13). With the exception of one single-center study (14), the handoff practices of intensivists have not been reported, and we know of no descriptions of how attending handoffs ought to be conducted.…”

Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills

“…An earlier observational study of critical care physicians also showed poor handoff communication skills in experienced clinicians. 27 These results are concerning if senior residents are expected to supervise actual patient handoffs performed by PGY-1 residents as suggested by other investigators. 5 Our findings also suggest that PGY-1 and PGY-2 residents were not able to accurately self-assess their handoff skills, with no correlation between objectively measured handoff skill and residents' self-confidence.…”

Improving postoperative handover from anaesthetists to non-anaesthetists in a children’s intensive care unit: the receiver’s perception

“…(11)(12)(13)(14) It has been suggested that communication flow during handover should be tailored to suit the structure of an institution and is dependent on processes such as provider transitions and trainee change of rotation. (13,15) Furthermore, anaesthetists and nurses often have different expectations regarding the content and timing of information transfer.…”