• Yanika Kowitlawakul, Benjamin S H Leong, Adela Lua, Rana Aroos, Jie Jun Wong, Nicola Koh, Nicholette Goh, Kay Choong See, Jason Phua, and Amartya Mukhopadhyay.
• Alice Lee Centre for Nursing Studies, National University Health System, Singapore.
• Int J Qual Health Care. 2015 Apr 1; 27 (2): 99-104.

ObjectiveTo describe the characteristics and barriers in the handover process in a medical intensive care unit.DesignA cross-sectional descriptive study using a checklist to observe nurses and doctors during handover of patients in and out of the intensive care unit.SettingThe study was conducted at a 1000-bed tertiary hospital in Singapore. The unit admits all patients under university medicine clusters, except those needing cardiology services.ParticipantsHandover between 90 pairs (180 participants)-50 nurse-to-nurse (100 nurses) and 40 doctor-to-doctor (80 doctors)--were passively observed in real time during morning and evening shifts over weekdays.Main Outcome MeasuresThe number and types of distractions and their relationship to the time spent during handover, the information included during handover, and the number of working shifts.ResultsThe results showed that there were 1.26 (± 1.75) distractions per handover. In 45 (50%) handovers, no distraction occurred. The human factor was the most common distracting factor during handovers, whereas short message service and monitor alarms were not identified as distracting factors. The information included least often was 'do not resuscitate' (DNR). Nurses spent significantly longer during handovers than doctors.ConclusionThe findings provide information for improving the handover process during the transfer of patients in and out of the intensive care unit. Distractions during handovers are common and are associated with longer durations. Nurses and doctors rarely address DNR status during handover of ICU patients in this study.© The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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