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Deficits in information transfer between anaesthesiologist and postanaesthesia care unit staff: an analysis of patient handover

Siddiqui, Naveed; Arzola, Cristian; Iqbal, Mirza; Sritharan, Kobika; Guerina, Laarni; Chung, Frances; Friedman, Zeev

European Journal of Anaesthesiology: September 2012 - Volume 29 - Issue 9 - p 438–445
doi: 10.1097/EJA.0b013e3283543e43
Safety

Background: The immediate postoperative period is important, as the patient recovers from the acute derangements resulting from the surgical insult and anaesthesia. Incomplete or incorrect communication between the anaesthesiologist and the postanaesthesia care unit nurse during the transfer process may lead to dangerous clinical mistakes. The literature examining handovers from operating room to the postanaesthesia care unit is scarce.

Objectives: The primary objective of this study was to examine the current transfer practice through observation of handovers between the anaesthesiologists and the postanaesthesia care unit staff in order to identify data omissions. The secondary objective was to learn which data items the clinicians and nurses thought were a necessary part of the transfer process and whether this information was communicated at the time of handover.

Design: A prospective observational study.

Setting: Academic hospital in Toronto, Canada.

Participants and interventions: After Research Ethics Board approval, a prospective observational study was conducted at a university-affiliated teaching centre. During a 2-month period, multiple observations of patient handover were performed. The data provided were marked on a checklist. At the end of the study, participating nurses and physicians were surveyed regarding the necessity of communicating different items on the checklist.

Results: A total of 526 transfers were observed. Of 29 data items examined, only two items (type of surgery and analgesics given) were reported in more than 90% of handovers. Only three items (difficult intubation, ST-wave changes and co-morbidities/healthy) were reported in more than 80% of cases. Many items deemed as needed to be reported by the participants in the study were not communicated.

Conclusion: This study demonstrates that the handover process is inconsistent and in some cases information defined as important by the physicians and the nurses is not transferred. Further studies need to investigate whether a handover protocol leads to a minimisation of omissions in information transfer.

From the Department of Anaesthesia and Pain Management, Mount Sinai Hospital (NS, CA, MI, LG, ZF) and Department of Anesthesiology, Toronto Western Hospital, University Health Network (KS, FC), University of Toronto, Toronto, Ontario, Canada

Correspondence to Dr Naveed Siddiqui, MD, Assistant Professor, Department of Anaesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada Tel: +1 416 586 5270; fax: +1 416 586 8664; e-mail: naveed.siddiqui@uhn.ca

Published online 19 May 2012

© 2012 European Society of Anaesthesiology