title: Differences in the handover process and perception between nurses and residents in a critical care setting.
abstract: OBJECTIVE
  To identify the differences in practices and perceptions of handovers between nurses and residents in the critical care setting, so as to improve the quality of the process.
  
  
  BACKGROUND
  Critically ill patients with complex problems are ideal for the study of handovers. However, few handover studies have been conducted in intensive care units.
  
  
  METHODS
  Descriptive study using questionnaires.
  
  
  METHODS
  We interviewed all nurses and residents involved in handovers of patients admitted to and discharged from a medical intensive care unit over a period of one month. Interviews were guided by a questionnaire and conducted between 24-48 hours of handovers.
  
  
  RESULTS
  Out of 672 eligible participants, 580 (290 nurses and 290 residents) agreed to participate in the study (86·3% response rate). Compared to residents, nurses received more training on handovers, covered issues specific to allied health specialties more frequently during handovers, and reviewed patients earlier after handovers. The perceived importance of the different components of handover varied significantly: donor residents, donor nurses, recipient residents and recipient nurses emphasised the overall management plan, case complexity, management plan over the next 48 hours and past medical history, including allergies, respectively. Satisfaction in the handover was related to pre-handover review of electronic medical records, handover training and clarity level in the management plan following the handover, with only the last factor remaining significant on multivariate analysis.
  
  
  CONCLUSIONS
  More nurses than residents received prior training in handovers. Nursing handovers were more inclusive of allied health specialties. The perceived importance of the components of handover varied. Greater clarity in management plans was associated with better satisfaction.
  
  
  CONCLUSIONS
  Deficiencies in the handover process (lack of prior training in handovers, not including allied health specialties and not reviewing electronic records before handover) were identified, thus providing opportunities for mutual learning between nurses and residents.
authors.affiliation: Department of Medicine, National University Health System, Singapore, Singapore.
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: Benjamin S H
authors.initials: BS
authors.lastname: Leong
authors.forename: Adela
authors.initials: A
authors.lastname: Lua
authors.forename: Rana
authors.initials: R
authors.lastname: Aroos
authors.forename: Jie Jun
authors.initials: JJ
authors.lastname: Wong
authors.forename: Nicola
authors.initials: N
authors.lastname: Koh
authors.forename: Nicholette
authors.initials: N
authors.lastname: Goh
authors.forename: Kay Choong
authors.initials: KC
authors.lastname: See
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Yanika
authors.initials: Y
authors.lastname: Kowitlawakul
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003422:Critical Care; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D062209:Patient Handoff / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: communication; handover; intensive care unit; patient safety