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

Background Discharge from the ICU to the ward can be associated with negative outcomes. Local guidelines mandate documenting the occurrence and time of verbal handover between the ICU team and ward team to reduce this danger. However, adherence is inconsistent and incomplete. Objective This study aimed to improve the frequency and completeness of documented ICU-to-ward verbal handover using a human factors-informed intervention. The outcomes assessed were documentation-related process measures rather than handover quality or patient-centered clinical outcomes. Methods A closed-loop quality improvement project was conducted in a tertiary ICU in Sydney, Australia. Baseline data were collected over one week for all patients discharged to the ward (n=42 ICU discharges). Discharges home and patient deaths were excluded. A multifaceted intervention was implemented over two days, comprising a visual prompt, verbal reinforcement during a department meeting, and digital dissemination. The intervention was informed by human factors principles, aiming to reduce cognitive load and improve the reliability of safety-critical tasks. Re-audit was conducted four weeks later over another one-week period (n=43). Categorical data were analyzed using chi-squared (χ²) testing with significance set at p=0.05. One key limitation is that this study assessed documentation compliance and did not examine handover quality or patient outcomes. Results Documentation of verbal handover improved from 25/42 (59.5%) to 37/43 (86.0%), an absolute improvement of 26.5 percentage points (95% CI: 8.4 to 44.6; p=0.006). Documentation of handover timing improved from 9/25 (36.0%) to 30/37 (81.1%), an absolute improvement of 45.1 percentage points (95% CI: 22.4 to 67.7; p<0.001). Conclusion A simple, low-cost intervention informed by human factors principles significantly improved compliance with ICU discharge handover standards. By introducing environmental prompts and reducing reliance on memory-dependent processes, adherence to a safety-critical documentation process improved. More research is needed to assess the impact on patient care and the sustainability of change. This approach has the potential to be scalable, sustainable, and transferable to other high-risk transitions of care.