The pitfalls of postoperative theatre to intensive care unit handovers: a review of the current literature

Johan van der Walt, Ivan Joubert
2014 Southern African Journal of Anaesthesia and Analgesia  
REVIEW Introduction Patients are at their most vulnerable in the postoperative environment. This is refl ected in the many adverse incidents that occur during this time. 1 This critical period in patient care is characterised by downscaled monitoring and observation, the transfer of potentially unstable patients from theatre to the intensive care unit (ICU), and the transfer of responsibility for care from one group of caregivers to another. 1,2 This process, and the transfer of relevant
more » ... tion, characterises the essence of a postoperative handover. As an example, cardiac surgery patients are at even higher risk during this phase of their management. The physiological milieu post-cardiopulmonary bypass, lends itself to rapid haemodynamic changes with vulnerable myocardium and multi-organ involvement. 2,3 Cardiac patients often present with complex medical and surgical histories that require careful consideration during the postoperative handover. The accurate communication of intraoperative events is critical in optimising their postoperative ICU management. 3 For these reasons, it is important to enhance the information exchange during the postoperative handover from the theatre team to the ICU team. Unfortunately, the communication between the providers and receivers of handover reports is poor. This is owing to the unstructured presentation of information, the noisy ICU environment while dealing with unstable patients, and discussions between healthcare workers from different disciplines who function at different levels of training. 4 Poor communication potentially compromises ICU patients' management, and in addition, may lead to misinterpretation or delayed special investigations and drug errors. 4,5 Communication failure is the primary cause of adverse incidents in the postoperative environment. Postoperative handovers are often perceived to be hazardous and fragmented. 6-8 Despite the importance of adequately managing the postoperative period and handover as an integral part of patients' in-hospital treatment, few initiatives exist in the South African context to improve and facilitate this communication process. Literature search strategy and quality criteria A Medline search was completed via the PubMed search engine. Keywords included "handovers", "postoperative", "intensive care unit" and "cardiac". Reviews and original research were included. Articles that discussed training methodology and study methods relating to handovers in the postoperative period, and which included intensive care units, were also included. Numerous studies have explored the role of nursing staff in managing handovers in the ward, emergency room and ICU. [9] [10] [11] [12] [13] Other studies have focused on the handover process in daily ward rounds, or the sign-out process between physicians and other healthcare providers. 12-16 These studies were included in this study since the focus of the handover and environment during the daily ward round contains valuable communication insight into an environment which is analogous to the postoperative handover. Twelve articles were selected to represent the current available literature on postoperative handovers in the ICU. The included articles consist of two review articles and 10 original research articles.
doi:10.1080/22201173.2014.936776 fatcat:dorcpkjyofg37ptgjzmzdaelwe