title: Optimizing postoperative handover to the intensive care unit at a tertiary centre.
abstract: BACKGROUND
  Comprehensive handover of patients transferred from operating theatre to the intensive care unit is crucial in ensuring ongoing quality and safety of care. Handover in this setting poses unique challenges, yet few studies have considered or tested approaches to improve the process. A quality improvement project was undertaken to assess and improve the quality of information transfer during the handover of postoperative patients to the general intensive care unit at a tertiary centre.
  
  
  METHODS
  This quality improvement project considered all postoperative patients aged 18 years and over, using the plan-do-study-act (PDSA) approach, over a 3-month period in 2015. Baseline audit encompassing intraoperative details (allergies, grade of intubation, estimated blood loss, difficulties and complications) and the postoperative plan (analgesia, thromboprophylaxis, antibiotics and their proposed duration and nutrition) was undertaken to define the extent of the clinical problem. Changes were implemented over two cycles, centred around a novel checklist, and the transfer of information was re-audited after each cycle.
  
  
  RESULTS
  Baseline audit (n=30) revealed a need for improvement across all domains. In PDSA cycle 1, a novel checklist was introduced which led to global improvement across all areas with performance exceeding 70% in all but three out of nine domains (n=33). Engaging key stakeholders (PDSA cycle 2) resulted in overall improvement from baseline but decreased performance in just under half of domains in comparison to PDSA cycle 1 (n=31).
  
  
  CONCLUSIONS
  Successful implementation of a series of simple interventions resulted in more effective handover of postoperative patients admitted to an intensive care unit. Sustained long-term improvement is a major challenge and can only be achieved with the global engagement of all staff and incorporation of changes into routine clinical practice.
authors.affiliation: Academic Foundation Year 1 Doctor, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London.
authors.forename: Shankar
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Foundation Year 1 Doctor, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London SW17 0QT.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: McKean
authors.affiliation: Consultant Colorectal Surgeon, Department of Colorectal Surgery, St George's University Hospitals NHS Foundation Trust, London.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ramwell
authors.affiliation: Consultant Anaesthetist and National Emergency Laparotomy Quality Improvement Lead, Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Johnston
authors.affiliation: Consultant in Intensive Care, Respiratory and General Medicine, General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London.
authors.forename: Susannah
authors.initials: S
authors.lastname: Leaver
mesh_terms: D057189:Checklist; D003266:Continuity of Patient Care; D006801:Humans; D007362:Intensive Care Units; D009873:Operating Rooms; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer / Q000592:standards; D058996:Quality Improvement