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A Multidisciplinary QI Initiative to Improve OR–ICU Handovers

Krimminger, Dawn, PhD, RN, CCRN; Sona, Carrie, MSN, RN, CCNS, CCRN; Thomas-Horton, Elaine, MSN, RN, CCRN; Schallom, Marilyn, PhD, RN, CCNS

AJN, American Journal of Nursing: February 2018 - Volume 118 - Issue 2 - p 48–59
doi: 10.1097/01.NAJ.0000530248.45711.60
Cultivating Quality

Background: Handover from the operating room (OR) staff to the ICU staff is a critical transition time for patients, in which the potential for error and miscommunication is high. Therefore, minimization of extraneous interruptions during the exchange of crucial information between the anesthesia and surgical teams and the nursing, respiratory therapy, and medical teams is imperative.

Objectives: The aim of this quality improvement (QI) initiative was, first, to examine the impact of a standardized handover process between the OR and the ICU on process and information-sharing errors, and second, to examine provider satisfaction with the handover process.

Methods: We conducted prospective observations of the handover process before and after implementation of the QI initiative. In the pre–process improvement period, 38 cardiothoracic patients were observed during handover. In the post–process improvement period, 38 patients were observed after implementation of the newly developed, standardized handover process and communication template. Provider satisfaction surveys were distributed at each observation during the pre– and post–process improvement periods.

Results: Compared with the pre–process improvement period, there was a significant decrease in interruptions during report in the post–process improvement period (1.7 ± 1.1 to 0.13 ± 0.34). There were also significantly fewer handover process errors (6.1 ± 2.8 to 1.7 ± 1.5), and fewer information-sharing errors (5.2 ± 2.7 to 2.3 ± 1.5). Average report time increased slightly, from 13.2 ± 6.8 minutes to 14.6 ± 3.8 minutes, but the increase was not significant. A total of 211 provider satisfaction surveys were completed in the pre–process improvement period and 95 in the post–process improvement period. Providers in all disciplines completed surveys in both time periods, and there was no significant difference in the percentage of respondents from any discipline. Responses to the following survey items showed significant improvement in the post–process improvement period: surgery report was satisfactory, anesthesia report was satisfactory, could hear all the report, pre-op anesthesia information was helpful, and start and end of handover were clear. Post–process improvement as well, more respondents disagreed that the person handing off the patient was under time pressure and that the person taking on responsibility for the patient was under time pressure.

Conclusion: A standardized OR–ICU handover process developed by a multidisciplinary team decreased handover process and information-sharing errors and increased provider satisfaction, with no significant increase in handover time.

This QI study examines the impact of a standardized handover process on ensuring safe patient transfer between the OR and the ICU.

Dawn Krimminger is a staff nurse in the cardiothoracic ICU at Barnes-Jewish Hospital in St. Louis, where Carrie Sona is a clinical nurse specialist in surgical intensive care, Elaine Thomas-Horton is a clinical nurse manager in the cardiothoracic ICU, and Marilyn Schallom is a research scientist. Contact author: Dawn Krimminger, The authors have disclosed no potential conflicts of interest, financial or otherwise.

This article was the winner of the 2017 Nurse Faculty Scholars / AJN Mentored Writing Award (for more information, go to

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