Enhancing ICU-to-Ward Handover Documentation Through a Human Factors Approach

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Human Factors Engineering

Background:

• Discharge from Intensive Care Unit (ICU) to general wards can lead to adverse outcomes.
• Inconsistent adherence to documenting verbal handover between ICU and ward teams poses a risk.
• Local guidelines mandate, but inconsistently achieve, documentation of verbal handover occurrence and timing.

Purpose of the Study:

• To enhance the frequency and completeness of documented ICU-to-ward verbal handover.
• To implement a human factors-informed intervention to improve a safety-critical documentation process.
• To assess documentation-related process measures following the intervention.

Main Methods:

• A closed-loop quality improvement project in a tertiary ICU.
• A multifaceted intervention including visual prompts, verbal reinforcement, and digital dissemination.
• Pre- and post-intervention audits of documentation compliance over one-week periods.

Main Results:

• Documentation of verbal handover improved significantly from 59.5% to 86.0%.
• Documentation of handover timing saw a substantial increase from 36.0% to 81.1%.
• The intervention demonstrated a statistically significant improvement in documentation compliance (p<0.006).

Conclusions:

• A simple, low-cost, human factors-informed intervention effectively improved ICU discharge handover documentation.
• Environmental prompts and reduced reliance on memory improved adherence to safety-critical documentation.
• The approach shows potential for scalability, sustainability, and transferability to other care transitions.