BJA Advance Access originally published online on June 13, 2008
British Journal of Anaesthesia 2008 101(3):332-337; doi:10.1093/bja/aen168
Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room
1 Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK
2 School of Nursing and Midwifery, University of Southampton, Southampton, UK
3 Centre for Medical Education
4 Institute for Health Research, Lancaster University, Lancaster, UK
* Corresponding author. E-mail: andrew.f.smith{at}mbht.nhs.uk
Background: We aimed to describe how anaesthetists hand over information and professional responsibility to nurses in the operating theatre recovery room.
Methods: We carried out non-participant practice observation and in-depth interviews with practitioners working in the recovery room of an English hospital and used qualitative methods to analyse the resulting transcripts.
Results: We observed 45 handovers taking place between 17 anaesthetists and 15 nurses in the recovery room of the operating theatre suite. These took place in an environment that is event-driven, time-pressured, and prone to concurrent distractions. Anaesthetists and nurses often had differing expectations of the content and timing of information transfer. The point at which transfer of responsibility for the patient occurred during the handover process was variable and depended not only on the condition of the patient but also on the professional relationship between the nurse and doctor concerned. Handover also provided an ‘audit point’ in care where the patient’s intraoperative progress was reviewed and plans were made for further management. Here, as in the transfer of responsibility, we found evidence that nurses play a greater role in defining the limits of anaesthetists’ practice than might be expected.
Conclusions: Patient handovers in the recovery room are largely informal, but nevertheless show many inherent tensions, both professional and organizational. Although formalized handover procedures are often advocated for the promotion of safety, we suggest that they are likely to work best when the informal elements, and the cultural factors underlying them, are acknowledged.
Keywords: anaesthesia, recovery period; communication; education, continuing; interprofessional relations; postoperative care; recovery, postoperative
An abstract outlining the ideas elaborated in this paper was presented at the European Association for Communication in Healthcare meeting, Basel, Switzerland, September 2006.
Declaration of interest. Professor A.F.S. is the recipient of a personal patient safety research development award from the UK National Institute for Health Research.
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