title: The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study.
abstract: BACKGROUND
  Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it.
  
  
  OBJECTIVE
  The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries.
  
  
  METHODS
  This was a descriptive comparative study.
  
  
  METHODS
  The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units).
  
  
  METHODS
  A convenience sample of 157 handovers was studied.
  
  
  METHODS
  Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors.
  
  
  RESULTS
  The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=<.001; unit: F(6,150)=58.24, p=<.001), for the end of life subscale (country: F(2, 154)=28.23, p<.001; unit: F(6,150)=25.25, p=<.001), the family communication subscale (country: F(2,154)=15.04, p=<.001; unit: F(6,150)=27.38, p=<.001), the family needs subscale (F(2,154)=22.33, p=<.001; unit: F(6,150)=42.45, p=<.001) but only for units on the process subscale (F(6,150)=8.98, p=<.001. The total handover score was higher if the oncoming RN did not know the patient (F(1,155)=6.51, p=<.05), if the patient was expected to die during the shift (F(1,155)=89.67, p=<.01) and if the family were present (F(1,155)=25.81, p=<.01).
  
  
  CONCLUSIONS
  Practices of end-of-life-handover communication vary greatly between units. However, room for improvement exists in all areas in all of the units studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool.
authors.affiliation: Hadassah Hebrew University, School of Nursing at the Faculty of Medicine, Jerusalem, Israel. Electronic address: Freda@hadassah.org.il.
authors.forename: Freda DeKeyser
authors.initials: FD
authors.lastname: Ganz
authors.affiliation: Critical Care Nursing, Plymouth University, Faculty of Health, Plymouth, UK; Monash University, Nursing & Midwifery, Melbourne, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.affiliation: NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith University, PMB 50 Gold Coast Mail Centre, Bundall, QLD 9726, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.affiliation: Hadassah Medical Organization, Jerusalem, Israel.
authors.forename: Julie
authors.initials: J
authors.lastname: Benbinishty
authors.affiliation: Intensive Care Unit, Kaplan Medical Organization, Rehovot, Israel.
authors.forename: Maureen
authors.initials: M
authors.lastname: Ben Nun
authors.affiliation: Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Ryan
authors.affiliation: Intensive Therapy Unit, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Schoter
authors.affiliation: Critical Care, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Boulanger
authors.affiliation: Critical Care, Taunton & Somerset Hospital NHS Foundation Trust, Taunton, Somerset, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chamberlain
authors.affiliation: Adult Intensive Care Services, The Prince Charles Hospital and University of Queensland, Chermside, QLD, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Spooner
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D038622:Internationality; D009741:Nursing Staff, Hospital; D062209:Patient Handoff / Q000592:standards*; D011785:Quality Assurance, Health Care; D013727:Terminal Care
keywords: Communication; End of life; Handover; Intensive care unit; Nurse