Enhancing Transfer of Accountability in Burn Intensive Care Unit Nursing: A Quality Improvement Initiative

Area of Science:

• Nursing
• Patient Safety
• Quality Improvement

Background:

• Effective nurse handovers are crucial in the burn intensive care unit (ICU) for patient safety.
• Communication gaps during transfer of accountability (TOA) lead to preventable safety incidents.

Purpose of the Study:

• To design and implement a standardized, burn-specific TOA tool to improve patient safety and safety culture in the burn ICU.
• To reduce handover-related communication failures and associated safety incidents.

Main Methods:

• A quality improvement initiative involved co-developing a structured TOA tool with frontline nurses.
• The tool was implemented via targeted education and eight weekly Plan-Do-Study-Act (PDSA) cycles.
• Outcomes measured included incident rates, safety culture scores, and tool adherence.

Main Results:

• Safety incidents decreased by 50% (from 18 to 9 per month).
• Nurse-reported safety culture scores improved by 20%.
• Tool adherence exceeded 90%, with nurses reporting improved clarity and reduced cognitive load.

Conclusions:

• A co-designed TOA tool, supported by education and iterative refinement, effectively enhanced handover safety in the burn ICU.
• This initiative offers a scalable model for improving communication and safety culture in high-risk clinical environments.