Identification of patient information corruption in the intensive care unit: Using a scoring tool to direct quality improvements in handover

Brian W Pickering, Killian Hurley, Brian Marsh

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Objective: To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety. Design: Handover assessment instrument development study divided into two phases by the introduction of a handover intervention. Setting: Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit. Subjects: Senior and junior medical members of the intensive care unit team. Interventions: Electronic handover page. Ements and Main Results: Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p <.05). Increasing median handover scores, 68.60 to 83.72, were associated with increases in clinical intention scores from 1 to 5 (chi-square = 23.59, df = 4, p <.0001). Conclusions: When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.

Original languageEnglish (US)
Pages (from-to)2905-2912
Number of pages8
JournalCritical Care Medicine
Volume37
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Quality Improvement
Intensive Care Units
Medical Errors
Medical Records
Patient Handoff
Critical Care
Safety

Keywords

  • Handover
  • Information technology
  • Infrastructure
  • Intensive care unit
  • Medical error
  • Organization
  • Quality indicators
  • Score

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Identification of patient information corruption in the intensive care unit : Using a scoring tool to direct quality improvements in handover. / Pickering, Brian W; Hurley, Killian; Marsh, Brian.

In: Critical Care Medicine, Vol. 37, No. 11, 11.2009, p. 2905-2912.

Research output: Contribution to journalArticle

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