https://doi.org/10.1177/1062860618754701
American Journal of Medical Quality
1–9
© The Author(s) 2018
Reprints and permissions:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1062860618754701
ajmq.sagepub.com
Literature Review
Patient care transitions are known to be complicated with
multiple simultaneous processes and can lead to adverse
events, communication problems, and technical disrup-
tions such as omission of a key task.
1
During transitions
of care, handovers or handoffs are “broadly defined as the
transfer of the patient, information, equipment, profes-
sional responsibility and accountability from one profes-
sional person or group to another, and may also include
strategies that promote education and teamwork.” (p. 227)
2
Accreditation Canada recognizes effective handover
communication during patient care transitions as a
required organizational practice.
3
Effective communica-
tion is defined as “accurate and timely exchange of infor-
mation that minimizes misunderstanding.”
3
Furthermore,
The Joint Commission has reported that substandard
handoffs may result in delays in treatment, inappropriate
treatment, adverse events, omission of care, increased
costs, and inefficiency from rework.
4
Operating room (OR) to intensive care unit (ICU)
handovers are inherently complex because of the severity
of the patient’s condition, the many equipment and moni-
toring devices, and the multiple team members from both
OR and ICU.
5
Thus, it has been suggested that having a
standardized OR to ICU handover will ensure effective
communication and help improve patient safety during
this critical transition period.
5
In keeping with the afore-
mentioned principles, the study institution has developed
and implemented a quality improvement (QI) project to
enhance OR to ICU handovers as part of an approach to
enhance patient safety during transitions of care. As part
of a multisite implementation of the new handover proto-
col, the study team sought to complete a scoping litera-
ture review.
5
Previous reviews of OR to ICU handover
literature have identified crucial elements of the handover
process, outlining components of a standardized process
and the effect on information transfer and reduction in
technical problems.
1,2,5-8
However, the scope of these
articles fails to explore the broad spectrum of standardized
754701AJM XX X 10.1177/1062860618754701American Journal of Medical QualityZjadewicz et al
research-article 2018
1
Alberta Health Services, Calgary, AB, Canada
2
University of Calgary, Calgary, AB, Canada
Corresponding Author:
Karolina Zjadewicz, RN, MN, Department of Critical Care Medicine,
Alberta Health Services, ICU Admin, McCaig Tower, Foothills
Medical Centre, 3134 Hospital Drive NW, Calgary, AB T2N 2T9,
Canada.
Emails: karolina.herold@ahs.ca, Karolina.zjadewicz@ahs.ca
Identifying What Is Known About
Improving Operating Room to Intensive
Care Handovers: A Scoping Review
Karolina Zjadewicz, RN, MN
1
, Kirsten S. Deemer, BScN, MN, ANP
1
,
Jennifer Coulthard, RN
1
, Christopher J. Doig, MD, MSc, FRCPC
1,2
,
and Paul J. Boiteau MD, FRCPC
1,2
Abstract
The purpose is to provide a descriptive overview of relevant material exploring improvement of handovers from the
operating room (OR) to intensive care unit (ICU). An online search (MEDLINE, Cochrane, EMBASE, CINAHL, and
Joanna Briggs), including gray literature and relevant reference lists, was completed. In all, 4574 unique citations were
screened and 155 full-text reviews performed; 65 articles were included in the final analysis. The majority of articles
discuss an ideal structure for handover (n = 63; 97%); 43 (66%) articles mentioned strategies for implementing such
an approach. Only 21 (32%) explicitly described formal quality improvement (QI) methods. Few explored project
sustainability and impact of a structured handover on patient safety outcomes (n = 15, 23%). Published literature
suggests that there is a significant gap in evidence of measured patient outcomes from standardization of OR to ICU
handover processes. Identifying formal QI strategies used to sustain standardized handover processes will allow
accurate measurement of patient outcomes.
Keywords
handover, communication, quality improvement, implementation