The effect of standard patient handover intervention on improving the quality of transfer from the operating room to the intensive care units


1 Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


Background: Handover from the operating room (OR) to the intensive care unit (ICU) is a complicated process that may endanger patients' lives. Objectives: The present study determined the effect of a standard patient handover protocol on the quality of transfer from the cardiac OR to the cardiac ICU. Methods: A quasi-experimental study was conducted in 2020 at an adult cardiac surgery center in Ahvaz city, Iran. Sixty-two handover cases were assessed before (n = 31) and after (n = 31) a training intervention on the nursing staff in the OR and ICU. The training intervention covered the process of standard handover. A checklist was used to evaluate the quality of care through the process of handover. The checklist consisted of three subscales. The independent samples t, Fisher's exact or chi-square tests were used to analyze the data. Results: The mean score of the technical errors was 10.61 ± 1.20 before the intervention and changed to 12.61 ± 0.80 after the intervention (P < 0.001). The mean score of ignoring information was 10.21 ± 1.78 before the intervention and changed to 14.00 ± 1.92 following the intervention (P < 0.001). Conclusion: Implementation of a standard handover protocol for post-cardiac surgery patients can decrease the intermission and improve the quality of care during patient handover.


1.     Petrovic MA, Aboumatar H, Scholl AT, Gill RS, Krenzischek DA,
Camp MS, et al. The perioperative handoff protocol: Evaluating
impacts on handoff defects and provider satisfaction in adult
perianesthesia care units. J Clin Anesth 2015;27:111-9.
2.     Abraham J, Nguyen V, Almoosa KF, Patel B, Patel VL. Falling
through the cracks: Information breakdownsin critical care handoff
communication. AMIAAnnu Symp Proc 2011;2011:28-37.
3.     Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D,
Thornlow DK, et al. Durham VA Patient Safety Center of Inquiry.
Can we make postoperative patient handovers safer? A systematic
review of the literature. Anesth Analg 2012;115:102-15.
4.     Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO. Handoff
strategies in settings with high consequences for failure: Lessons
for health care operations. Int J Qual Health Care 2004;16:125-32.
5.     Manser T, Foster S, Gisin S, Jaeckel D, Ummenhofer W. Assessing
the quality of patient handoffs at care transitions. Qual Saf Health
Care 2010;19:e44.
6.     Abraham J, Kannampallil T, Patel VL. A systematic review of
the literature on the evaluation of handoff tools: Implications for
research and practice. J Am Med Inform Assoc 2014;21:154-62.
7.     Lane-Fall MB, Beidas RS, Pascual JL, Collard ML, Peifer HG,
Chavez TJ, et al. Handoffs and Transitions in Critical Care
(HATRICC): Protocol for a mixed methods study of operating
room to intensive care unit handoffs. BMC Surg 2014;14:96.
8.     Gleicher Y, Mosko JD, McGhee I. Improving cardiac operating
room to intensive care unit handover using a standardised handover
process. BMJ Open Qual 2017;6:e000076.
9.     Holden RJ, Daley CN, Mickelson RS, Bolchini D, Toscos T,
Cornet VP, et al. Patient decision-making personas: An application
of a Patient-Centered Cognitive Task Analysis (P-CTA). Appl
Ergon 2020;87:103107.
10.     Joy BF, Elliott E, Hardy C, Sullivan C, Backer CL, Kane JM.
Standardized multidisciplinary protocol improves handover of
cardiac surgery patients to the intensive care unit. Pediatr Crit Care
Med 2011;12:304-8.
11.     Dusse F, Pütz J, Böhmer A, Schieren M, Joppich R, Wappler F.
Completeness of the operating room to intensive care unit
handover: A matter of time? BMC Anesthesiol 2021;21:38.
12.     Wibrandt I, Lippert A. Improving patient safety in handover from
intensive care unit to general ward: A systematic review. J Patient
Saf 2020;16:199-210.
13.     Peer M, O’Regan NB, Evans B, Fowler A, Dubrowski A. Patient
handover in emergency trauma situations. Cureus 2020;12:e9544.
14.     Kiekkas P, Michalopoulos E. Patient handover in the PACU: When
less can be more. J Perianesth Nurs 2020;35:343-4.
15.     Salzwedel C, Mai V, Punke MA, Kluge S, Reuter DA. The effect
of a checklist on the quality of patient handover from the operating
room to the intensive care unit: A randomized controlled trial. J
Crit Care 2016;32:170-4.
16.     Münter KH, MøllerTP, Østergaard D, Fuhrmann L.Implementation
of an electronic checklist to improve patient handover from ward to
operating room. J Patient Saf 2020;16:156-61.
17.     Chenault K, Moga MA, Shin M, Petersen E, Backer C,
De Oliveira GS Jr, et al. Sustainability of protocolized handover
of pediatric cardiac surgery patients to the intensive care unit.
Paediatr Anaesth 2016;26:488-94.
18.     Zavalkoff SR, Razack SI, Lavoie J, Dancea AB. Handover after
pediatric heart surgery: A simple tool improves information
exchange. Pediatr Crit Care Med 2011;12:309-13.
19.     Kaufmnan J,Twite M,BarrettC, PeytonC, KoehlerJ,Rannie M, et al.
Ahandoff protocol from the cardiovascular operating room to cardiac
ICU is associated with improvements in care beyond the immediate
postoperative period. Jt Comm J Qual Patient Saf 2013;39:306-11.
20.     Saver C. Handoffs: What ORs can learn from formula one race
crews? OR Manager 2011;27:11-3.
21.     Ong MS, Coiera E. A systematic review of failures in handoff
communication during intrahospital transfers. Jt Comm J Qual
Patient Saf 2011;37:274-84.
22.     KarakayaA, MoermanAT, Peperstraete H, François K, Wouters PF,
de Hert SG. Implementation of a structured information transfer
checklist improves postoperative data transfer after congenital
cardiac surgery. Eur J Anaesthesiol 2013;30:764-9.
23.     Craig R, Moxey L, Young D, Spenceley NS, Davidson MG.
Strengthening handover communication in pediatric cardiac
intensive care. Paediatr Anaesth 2012;22:393-9.
24.     Beigmoradi S, Pourshirvani A, Pazokian M, Nasiri M. Evaluation
of nursing handoff skill among nurses using situation-backgroundassessment-recommendation checklist in general wards. Evid
Based Care J 2019;9:63-8.
25.     Halterman RS, Gaber M, Janjua MST, Hogan GT, Cartwright SMI.
Use of a checklist for the postanesthesia care unit patient handoff.
J Perianesth Nurs 2019;34:834-41.