Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.
OBJECTIVE
To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety.


METHODS
Handover assessment instrument development study divided into two phases by the introduction of a handover intervention.


METHODS
Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit.


METHODS
Senior and junior medical members of the intensive care unit team.


METHODS
Electronic handover page.


RESULTS
Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p < .05). Increasing median handover scores, 68.60 to 83.72, were associated with increases in clinical intention scores from 1 to 5 (chi-square = 23.59, df = 4, p < .0001).


CONCLUSIONS
When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.
Pickering
Brian W
BW
Department of Intensive Care Medicine, Mater Misericordiae Hospital, Dublin, Ireland. brian.pickering@ucd.ie
Hurley
Killian
K
Marsh
Brian
B
D003266:Continuity of Patient Care; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D019300:Medical Errors / Q000517:prevention & control; D008499:Medical Records; D011939:Mental Recall; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires