The art of handing over

Abstract

This graduation project aimed to enhance the patient handovers at the Intensive Care Unit (ICU) by design based on experienced qualities and pain points by the ICU team, existing of doctors and nurses. At the ICU, care is delivered by multidisciplinary healthcare teams who strongly rely on teamwork and communication. Patient handovers are scheduled moments of communication, where information between different healthcare professionals is exchanged. However, there exists an unaccepted rate of unintended patient harm which can be attributed to failures in communication. These failures can be the result of educational, psychological, and organisational factors. To discover how design can overcome these failures in information sharing, observations and interviews within the ICU context were done. The aim of the observations was to understand and interpret the behaviour of ICU doctors and nurses throughout the day and during handovers. The purpose of the interviews was to get a deeper understanding of their personal experience with the different handover moments. The observations provided insights in the interactions between doctors, nurses, and both groups. Discovered communication breakdowns were captured in three different work models. The interviews revealed the experienced qualities and pain points during handovers. Altogether, both activities resulted in three ingredients which need to be considered while designing for enhanced handovers: information sharing, teamwork, and context.
Based on the findings, ICoon was developed in extensive collaboration with the ICU team. ICoon is a tool facilitating that the patient handovers are experienced as more effective and efficient. The tool exists of three different components: ‘overdragen’, ‘overhebben’, and ‘overzien’. ‘Overdragen’, allows that the complete ICU team will have the same expectations of each handover moment and entails that only relevant information is shared in an efficient way. ‘Overzien’ is an addition to the current Patient Data Management System (PDMS), allowing the ICU team to have a proper overview of the patient population on each unit and is supportive in efficiently handing over patients during shift changes. The last component, ‘over hebben’, will enable the ICU team to continuously reflect together on their handover process triggering organisational change. The last step of this design process was to elaborately evaluate ICoon with the ICU team. The aim of the evaluation was twofold: figuring out the added value of ICoon within the ICU regarding the experienced effectiveness and efficiency and assessing the support ‘overzien’ facilitates during patient handovers. Compared to the current situation, the ICU team agreed that ‘overdragen’ provides focus and structure, ‘overzien’ brings overview, and ‘over hebben’ can have a positive impact on the teamwork within and between the team of nurses and team of doctors. The concept ICoon in combination with the involvement of the ICU team resulted into tools and capacities for the realization of innovation at the ICU. The adopted human-centred design approach and engagement with the doctors as well as the nurses resulted into co-commitment of the ICU team, which turned out to be an important first step towards implementation of design solutions within the ICU. Therefore, ICoon turned out to serve as tool for transformation rather than a design solution only.