Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room.
BACKGROUND
We aimed to describe how anaesthetists hand over information and professional responsibility to nurses in the operating theatre recovery room.


METHODS
We carried out non-participant practice observation and in-depth interviews with practitioners working in the recovery room of an English hospital and used qualitative methods to analyse the resulting transcripts.


RESULTS
We observed 45 handovers taking place between 17 anaesthetists and 15 nurses in the recovery room of the operating theatre suite. These took place in an environment that is event-driven, time-pressured, and prone to concurrent distractions. Anaesthetists and nurses often had differing expectations of the content and timing of information transfer. The point at which transfer of responsibility for the patient occurred during the handover process was variable and depended not only on the condition of the patient but also on the professional relationship between the nurse and doctor concerned. Handover also provided an 'audit point' in care where the patient's intraoperative progress was reviewed and plans were made for further management. Here, as in the transfer of responsibility, we found evidence that nurses play a greater role in defining the limits of anaesthetists' practice than might be expected.


CONCLUSIONS
Patient handovers in the recovery room are largely informal, but nevertheless show many inherent tensions, both professional and organizational. Although formalized handover procedures are often advocated for the promotion of safety, we suggest that they are likely to work best when the informal elements, and the cultural factors underlying them, are acknowledged.
Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK. andrew.f.smith@mbht.nhs.uk
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D000762:Anesthesia Recovery Period; D000776:Anesthesiology / Q000458:organization & administration*; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration; D004739:England; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D016528:Postanesthesia Nursing / Q000458:organization & administration*; D011182:Postoperative Care / Q000451:nursing* / Q000523:psychology; D011364:Professional Practice; D011997:Recovery Room; D017751:Safety Management / Q000458:organization & administration