Challenges for conducting and teaching handovers as collaborative conversations: an interview study at teaching ICUs.

Area of Science:

• Medical Education
• Patient Safety
• Healthcare Communication

Background:

• Medical shift handovers are crucial for more than just information transfer.
• However, their use for reflection, learning, or discussion remains inconsistent.
• Understanding the dynamics of incorporating these functions into Intensive Care Unit (ICU) handovers is vital for educational program design.

Purpose of the Study:

• To explore ICU physicians' perceptions of shift handover functionality.
• To identify the boundaries of what can be achieved during handover conversations.
• To determine training requirements and interaction challenges in ICU shift handovers.

Main Methods:

• Semi-structured interviews were conducted with 21 intensivists, residents, and fellows from three ICUs.
• Interviews focused on perceptions of handover functions and limitations.
• Qualitative analysis was used to identify training needs and interaction barriers.

Main Results:

• ICU physicians identified three key handover functions: information transfer, enhancing shared understanding and decision-making, and learning.
• The emphasis on these functions was influenced by case, individual, team, and unit workflow characteristics.
• Situational factors sometimes created dilemmas and misaligned expectations regarding handover capabilities.

Conclusions:

• ICU handover education should extend beyond mere information transfer, especially in complex settings.
• Training should evolve to foster more adaptable handover approaches and resident engagement in reflection and discussion.
• Addressing interaction challenges is essential to redefine handovers as sources of safety and learning, mitigating potential errors.