ICU · Ethics

Acute severe community-acquired pneumonia: ICU handover and communication

Also known as ICU handover · Communication in ICU · SBAR handover · Clinical handover

Clinical handover is the transfer of professional responsibility and accountability for patient care from one clinician/team to another. Poor handover is a leading cause of preventable patient harm — the Joint Commission attributed the majority of sentinel events to communication breakdown, and the ANZICS CORE and ICNARC datasets repeatedly identify failed handover as a root-cause contributor to ICU morbidity. ICU handover contexts: shift change (nursing + medical), ICU-to-ward transfer, ED-to-ICU referral/upgrade, inter-hospital retrieval, weekend/holiday/long-weekend handover, and emergency/event handover (cardiac arrest, rapid response, deterioration). Structured tools: ISBAR (Identify, Situation, Background, Assessment, Recommendation — the ANZ standard with explicit identification step), SBAR (Situation, Background, Assessment, Recommendation — the original Kaiser Permanente model), I-PASS (Illness severity, Patient summary, Action list, Situation awareness with contingencies, Synthesis by receiver — most evidence-based, reduced medical errors 23% and preventable adverse events 30% in the NEJM 2014 trial), and ISOBAR (Identify, Situation, Observations, Background, Agreed plan, Read-back — Australian Commission on Safety and Quality in Health Care variant). Handover failure modes: missed information, wrong/duplicated/omitted medication, delayed investigation or treatment, loss of contingency plans, and absent situational awareness of the deteriorating patient. Critical-event communication techniques: closed-loop communication (sender → receiver reads back → sender confirms), read-back/verify-back of verbal orders and drug doses, and crew resource management (CRM) principles adapted from aviation. Principles of every handover: structured, concise, accurate, timely, documented in the medical record, with an explicit opportunity for questions and a synthesis/read-back step.