Handovers Among Staff Intensivists: A Study of Information Loss and Clinical Accuracy to Anticipate Events*

Objectives: Handovers are associated with medical errors, and our primary objective is to identify missed diagnosis and goals immediately after a shift handover. Our secondary objective is to assess clinicians’ diagnostic accuracy in anticipating clinical events during the night shift. Design: Single-center prospective observational cohort study. Setting: Thirty-bed tertiary ICU in Sao Paulo, Brazil. Patients: Three-hundred fifty-two patient encounters over 44 day-to-night handovers. Interventions: None. Measurements and Main Results: We used a multimethods approach to measure transmission of information among staff physicians on diagnoses and goals for the night shift. We surveyed clinicians immediately after a handover and identified clinical events through chart abstractions and interviews with clinicians the next morning. Nighttime clinicians correctly identified 454 of 857 diagnoses (53%; 95% CI 50–56) and 123 of 304 goals (40%; 95% CI, 35–46). Daytime clinicians were more sensitive (65% vs 46%; p

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