Feature

Improving Postoperative
Handoff in a Surgical
Intensive Care Unit
Deborah A. Talley, MS, MPH, ACNP
Eleanor Dunlap, MS, ACNP
Dawn Silverman, MS, ACNP
Stephanie Katzer, MS, ACNP
Meredith Huffines, MS, RN
Cindy Dove, MS, RN
Megan Anders, MD, MS
Samuel M. Galvagno, DO, PhD
Samuel A. Tisherman, MD

Background Evidence-based research demonstrates that postoperative formalized handoff improves com-
munication and satisfaction among hospital staff members, leading to improved patient outcomes.
Objective To improve postoperative patient safety in the surgical intensive care unit of a tertiary academic
medical center.
Methods A verbal and written formal reporting method was designed, implemented, and evaluated. The
intervention created an admission “time-out,” allowing the handoff from surgical and anesthesia teams to
the intensive care unit team and bedside nurses to occur in a more structured manner. Before and 1 year
after implementation of the intervention, nurses completed surveys on the quality of postoperative handoff.
Results After the intervention, the proportion of nurses who reported receiving handoff from the surgical
team increased from 20% to 60% (P < .001). More nurses felt satisfied with the surgical handoff (46% before
vs 74% after the intervention; P < .001), and more nurses frequently felt included in the handoff process
(42% vs 74%; P < .001). Nurses perceived improved communication with surgical teams (93%), anesthesia
teams (89%), and the intensive care unit team (94%), resulting in a perception of better patient care (88%).
Conclusion After implementation of a systematic multidisciplinary handoff process, surgical intensive
care nurses reported improved frequency and completeness of the postoperative handoff process, result-
ing in a perception of better patient care. (Critical Care Nurse. 2019;39[5]:e13-e21)

H
ealth care provider (HCP) handoff is a time when shortcomings in communication can result
in patient harm, particularly in the postoperative period, when the patient’s physiology is
changing rapidly. The Joint Commission has reported that two-thirds of sentinel events result
from communication errors and that more than 50% of these sentinel events occur during HCP handoff.1

©2019 American Association of Critical-Care Nurses doi:https://doi.org/10.4037/ccn2019523

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 Intensive care units (ICUs) have higher rates of adverse patients require a postoperative stay in an ICU. These
events due to medical error than other units, especially surgical patients receive care from multiple subspecial-
as a result of inadequate HCP handoff from the operat- ties and are often managed by multiple services during
ing room to the ICU.2 Intensive care unit patients are their hospital stay, requiring multiple HCP handoffs that
particularly vulnerable because of the need for invasive put them at risk for potential errors in care. Formalized
hemodynamic monitoring, administration of high-risk HCP handoff ensures that information exchange is stan-
medications, and frequent performance of invasive pro- dardized and comprehensive so that the receiving spe-
cedures, all of which provide opportunities for error. cialists and surgical ICU (SICU) nurses can quickly move
For patients undergoing surgery, one study showed that forward in providing individualized, high-quality, and
almost 15% of postoperative adverse events were due to safe patient care.
communication failures.3 Standardized checklist-driven
handoff Rationale for Intervention
Communication errors are the most processes Health care provider handoff is a multidisciplinary,
common root cause of sentinel events have been collaborative activity involving information transfer,
in the hospital environment. shown to sequenced tasks, and high-quality teamwork.6 Struc-
improve tured reporting tools, for both verbal and written com-
the quality of information exchanged during handoff munication, have been found to promote patient safety
and to minimize extraneous diagnostic testing and proce- and improve the quality of HCP handoff.7 A comprehen-
dures.4 Furthermore, handoff between HCPs can be an sive handoff allows for review of perioperative events and
opportune time for teaching and clinical review.5 Precise development of a shared understanding about expecta-
communication among the teams is an essential part of tions during the postoperative period, activities that pro-
keeping patients safe. mote a seamless and safe transition in care. Written
The University of Maryland Medical Center provides handoff documents provide a formalized structure for
care to more than 7500 patients annually; many of these verbal communication. These communication scripts
can help teams avoid errors of omission and provide
Authors structure that allows HCPs to know when to expect
Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stepha- what information. A huddle format emphasizing verbal
nie Katzer are acute care nurse practitioners in the surgical intensive
care unit, University of Maryland Medical Center, Baltimore, communication permits ICU providers to ask questions
Maryland. and seek clarification so that an individualized, safe
Meredith Huffines is a senior clinical nurse II in the surgical inten- plan of care can be implemented immediately in the
sive care unit, University of Maryland Medical Center. postoperative period. As noted by the Agency for
Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Healthcare Research and Quality’s TeamSTEPPS (Team
Services, University of Maryland Medical Center.
Strategies & Tools to Enhance Performance & Patient
Megan Anders is an anesthesiologist and Associate Chair for Safety Safety), teamwork is the key that can transform the cul-
and Quality, Department of Anesthesiology, University of Maryland
Medical Center. ture of health care to focus on safety.8 A written report
Samuel M. Galvagno is an associate professor and Associate Medi- also allows subsequent caregivers to fully understand
cal Director, surgical intensive care unit, University of Maryland the patient’s procedure and plan by documenting criti-
Medical Center, and Associate Chief Medical Officer, Maryland
Critical Care Network, Baltimore. He is a colonel in the US Air Force cal points of the verbal handoff.
and Director of Critical Care Air Transport Team operations, 943rd Governmental bodies including The Joint Commis-
Aerospace Medicine Squadron, Davis-Monthan Air Force Base, sion, the Agency for Healthcare Research and Quality,
Arizona.
and the National Academy of Medicine have recom-
Samuel A. Tisherman is Medical Director, surgical intensive care
unit, surgical intermediate care unit, and the Center for Critical Care mended developing a formalized HCP handoff process
and Trauma Education, University of Maryland Medical Center. to improve both communication and patient safety. The
Corresponding author: Deborah A. Talley, MS, MPH, ACNP, 22 S Green St, Baltimore, Joint Commission reported that communication errors
MD 21201 (email: [email protected]). are the most common root cause of sentinel events, with
To purchase electronic or print reprints, contact the American Association of Critical- HCP handoff being a significant contributor to these
Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or
(949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected]. events. Additionally, in 2006 The Joint Commission

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established National Patient Safety Goal 2E, which a patient may travel between the ICU and the operating
requires a standardized process for handoffs.1 To target room (OR) multiple times over the course of days or
this communication issue, The Joint Commission devel- weeks. Before implementation of the project, the anes-
oped the “Targeted Solutions Tool for Hand-off Commu- thesia team accompanied the patient to the SICU after
nications,” known as SHARE. This tool describes specific surgery and provided a verbal report and a copy of the
guidelines for handoff with the goal of refining the hand- intraoperative hemodynamics and medication adminis-
off procedure and improving the process of information tration report to the nurse. The surgical team’s involve-
sharing in order to prevent delays in treatment. Root- ment was much more variable. At times, no provider
cause analyses were conducted by 10 leading US hospi- was present, or the provider present was not involved in
tals to develop these guidelines, which indicate that a the operation. The presence of a SICU physician, nurse
well-conducted handover process includes the following: practitioner, or physician assistant to receive report var-
Standardization of critical content; Hardwiring within ied, as did involvement of the bedside nurse.
the hospital system through the use of standardized tools;
Allowing for questions to be asked; Reinforcement of Intervention
quality measures through clinical governance and audits; The initial draft handoff tool was created and then
and Education and coaching for staff.9 piloted by a team of SICU nurses to improve surgical
handoff. This effort led to an expanded quality improve-
Specific Aims ment project and further development of the tool. Sub-
The collaborative quality improvement project sequent handoff tools were created by SICU nurse
described in this article was designed to formalize practitioners in partnership with the various surgical
postoperative written and verbal communication services. They included information such as diagnosis,
among HCPs by means of a standardized handoff pro- procedure, drains, hemodynamic goals, type and fre-
cess intended to improve patient safety and team satis- quency of nursing assessments, use of deep vein throm-
faction with the reporting process. Evidence-based bosis prophylaxis and antibiotics, future operative
research demonstrates that formalized handoff after sur- plans, and diet status. The written handoff included an
gery improves communication and satisfaction among anatomical
staff members, leading to improved patient outcomes. We drawing that “Operation Hard Stop” was developed
hypothesized that implementation of this project would could be by a multidisciplinary group to formalize
result in more positive perceptions among nurses of the used to iden- the postoperative written and verbal
handoff process and patient safety. tify specific report process.
bypasses,
Methods anastomoses, or drain locations. Report sheets were
Context edited to create a standardized format across services.
The University of Maryland Medical Center is a 757- These report sheets were then reviewed by the remain-
bed tertiary care facility serving the city of Baltimore der of the nurse practitioner group and the SICU medi-
and its surrounding communities. The hospital includes cal director. The report sheet was piloted, feedback was
11 ICUs, of which 1 is the SICU. The SICU is a 24-bed collected from all involved personnel (including physi-
unit that admits critically ill (nontrauma) patients who cians, nurses, and nurse practitioners), and the report
have undergone or are expected to undergo single or sheet was modified as necessary.
multiple procedures, including general, acute care emer- Concurrently, a multidisciplinary group including
gency, transplant, vascular, orthopedic, oncological, SICU fellows and attending physicians (both surgical
obstetric/gynecologic, otolaryngologic, thoracic, and and anesthesia), SICU nurses and leaders, and SICU
oral surgery. The mean age of patients in the SICU is 58 nurse practitioners developed a formalized postopera-
years, with 58% being male and more than 50% of the tive report process. The project was titled “Operation
patients having a chronic health condition.10 Hard Stop.” The process was mapped out on a flowchart
Surgical ICU patients are often admitted to the unit and included a description of the roles of the bedside
immediately after surgery. During a typical SICU stay, nurse, SICU provider, anesthesia team member, and

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 Patient arrives at ICU

Overhead Admission tasks

announcement • Untangle
• Roll
• Swab
Ensure immediate safety • Draw laboratory samples
(RN, RT, anesthesia clinician); 2-3 min average • Restraints
1. Transfer monitor and verify stable vital signs (done by secondary RN/PCT when available)
2. Connect patient to ventilator/oxygen Secondary RN alerts team if vital signs become
3. Identify resuscitation/“push” line (anesthesia unstable during handover  anesthesia clinician
clinician shows RN) will pause handoff
4. Restraint applied (if immediate danger)

Primary RN, RT, and

anesthesia clinician
ready for handoff

Structured handoff
Handoff confirmation
1. ICU provider admitting patient, fellow, surgery team,
1. Anesthesia clinician transfers
primary RN, RT, anesthesia clinician at bedside and
care of patient to ICU team
ready
and RN Transfer of
2. SICU leadership (provider/fellow) confirms group is
2. ICU team and RN confirm care
ready and announces handoff start: “hard stop for
acceptance and adequate completed
handoff”
transition of medications/plan
3. Surgical report (verbal and written)
if recent sedation, pressor,
4. Anesthesiology report
antihypertensive administered
5. QA/verification/clarification. Confirm “handoff complete.”

Figure 1 Operation Hard Stop flowchart.

Abbreviations: ICU, intensive care unit; PCT, patient care technician; QA, quality assurance; RN, registered nurse; RT, respiratory therapist; SICU, surgical ICU.

surgical team member (Figure 1). Signs that visually surveys. Survey questions were developed on the basis of
cued this new process were created and were posted in issues that were discussed by the multidisciplinary task
the patient’s room upon the patient’s arrival at the ICU force. This initial focus group identified concerns includ-
from the OR (Figure 2). ing the variation in reporting by anesthesia and surgical
Once the Operation Hard Stop process was created, teams, the overall difference in reporting by the different
education was provided to nurses via staff meetings, surgical teams, inclusion of SICU providers and nurses,
daily huddles, and email. Surgical and anesthesia resi- the amount of support that the primary nurse received
dents were informed by email, direct communication from other nurses, the nurse’s comfort in stepping away
from chiefs of the surgical services, SICU faculty, and a from the patient to receive a report, and the effect that
grand round presentation. In addition, the SICU medical years of nursing experience had on each of these issues.
director shared the report sheet with the SICU provider The survey items were reviewed by the multidisciplinary
team. The intervention began in June 2015. task force members.
The survey measured nurses’ satisfaction with post-
Evaluation of the Intervention operative reporting by surgical and anesthesia team mem-
In order to evaluate nurses’ perceptions of the inter- bers before and after the intervention. The preintervention
vention, we created preintervention and postintervention survey consisted of 13 items, and the postintervention

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 Figure 2 Operation Hard Stop bedside sign.
Abbreviations: ICU, intensive care unit; OR, operating room.

survey consisted of 15 items. The first 7 items compared questions asked about years of nursing experience. The 2
reporting procedures of the surgical and anesthesia teams. additional items in the postintervention survey focused
The next 4 items asked about the prioritization of activi- on nurses’ perception of the impact of the intervention
ties upon the patient’s return from the OR. The last 2 on the reporting process.

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 Table 1 Comparison of nurses’ perceptions of factors in handoff from surgical and anesthesia teams
before and after the intervention
From surgical team From anesthesia team
Before, % of After, % of Before, % of After, % of
Factor respondents respondents P respondents respondents P
Received handoff upon patient’s 20 60 < .001 78 88 .11
return from operating room
Satisfied with handoff 46 74 < .001 88 91 .59
Perceived handoff as important 84 88 .46 88 87 .80
Can identify providers 15 47 < .001 67 70 .75

Table 2 Comparison of nurses’ overall perceptions before and after the intervention
Before, % of After, % of
Perception respondents respondents P
Frequently feeling included in the handoff 42 74 < .001
Frequently feeling like all questions were answered 65 77 .12
Feeling comfortable speaking up 72 77 .55
Frequently feeling too busy with routine activities to stop and participate in handoff 32 12 .004
Frequently feeling too busy with urgent activities to stop and participate in handoff 26 11 .002

The survey was administered in a paper format to SICU was obtained from the nurse manager to assess
all staff nurses in the SICU during all shifts. The prein- response rate, participation in the survey was voluntary.
tervention survey was administered in May 2015, and The master list of staff nurses with their corresponding
the postintervention survey was administered in May identifiers was available to only 2 survey administrators
2016. A confidential numerical code was maintained and kept in a locked file. Every attempt was made to
by the project coordinators to link preintervention and keep the responses confidential.
postintervention surveys.
Results
Analysis Before the intervention, there were 74 staff nurses in
Data analysis was conducted using Microsoft Excel the SICU, of whom 93% participated in the survey. After
for Windows. The data were validated using double data the intervention, there were 86 staff nurses in the SICU,
entry. Descriptive statistics were created for each item. of whom 79% participated in the survey. The 2 groups
Eleven items used different variations of Likert scales, had similar proportions of nurses with less than 2 years
and 2 demographic questions included 7 different time of experience (22% before vs 24% after) and nurses with
options; dichotomous groups were then created for each 2 or more years of experience (78% vs 76%).
of these items. Another 2 items were answered as yes/no. The survey evaluated nurses’ perceptions of the hand-
All of the questions were then evaluated as dichotomous off process before and after the intervention (Tables 1
variables comparing the preintervention and postinterven- and 2). A statistically significant increase was found after
tion data using the χ2 test for unpaired data. Analysis was the intervention in the percentage of respondents report-
not completed on paired data. ing receiving handoff from the surgical team on the
patient’s return from the OR (20% before vs 60% after;
Ethical Considerations P < .001). A statistically significant increase was also
The study was reviewed by the University of Mary- found after the intervention in the percentage of respon-
land, Baltimore, institutional review board. The inter- dents reporting being satisfied with surgical handoff
vention, which was undertaken primarily as a quality (46% vs 74%; P = .001). No statistically significant differ-
improvement project, was deemed a non–human-research ence was found in the percentage of respondents report-
study. Although a census of all nurses employed by the ing receiving handoff from the anesthesia team (78%

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before vs 88% after; P = .11) or the percentage reporting from 2016 featured the same Plan-Do-Study-Act frame-
being satisfied with the anesthesia team’s handoff (88% work as used in this study, but the researchers used
vs 91%; P = .59). After the intervention, nurses were direct observation and focus groups instead of anony-
more likely to report frequently feeling included in the mous surveys to evaluate the results.13 They concluded
handoff (42% before vs 74% after; P < .001) and were that they
less likely to report frequently feeling too busy with
their activities to stop and participate in handoff. . . . were unable to examine the effects of the
The postintervention survey included several addi- [handover] redesign process on patient outcomes.
tional questions about the implementation of the for- However, improved team behaviors, reduced
malized handoff. Seventy-two percent of the respondents workload, and improved staff satisfaction . . .
reported that the formalized handoff was attempted fre- have all been linked to improved quality of care
quently. Nurses reported satisfaction with the interven- and patient outcomes in other care settings.13(p408)
tion, including perceived improved patient care (88%)
and communication with surgical teams (93%), the anes- Despite the differing study methodologies, the fact
thesia team (89%), and the ICU team (94%). that their study and our study reached similar conclu-
sions suggests that the findings are reproducible.
Discussion Our findings are also consistent with those of a recent
Evidence-based research has shown that a formalized study by Lane-Fall et al14 that examined facilitating fac-
handoff process improves both communication and patient tors and barriers related to the consistent practice of
safety, and this concept is supported by national govern- handoff. The authors reported that facilitating factors
mental bodies.1 The results of our survey of nurses indi- included prearrival notification, provider familiarity
cate that implementation of a quality improvement project with the patient, and physical presence of clinicians in
enhanced the quantity and quality of HCP handoffs in the patient’s room. Barriers included being rushed, lack
our SICU. Recent research on patient safety culture in of provider
hospitals indicated that behaviors, attitudes, and percep- availability, The factors that most contribute to
tions are interconnected, suggesting that improving per- and compet- patient safety are leadership support,
ceptions of communication during handoffs will result in ing priorities.14 communication, and teamwork.
positive behavioral changes. These behavioral changes, In our study,
in turn, may lead to improved patient safety.11 we found that nurses were less likely to report feeling
too busy to stop for participation in handoff after the
Interpretation intervention. This outcome supports the findings of
A recent systematic review of HCP handoffs by Segall Lane-Fall et al14 that implementation of a formalized
et al12 addressed whether postoperative patient handoffs handoff process can address some of the barriers to the
have been found to improve patient safety. The authors consistent practice of handoff.
found an association between poor-quality handoffs Human factors science and engineering may help
and adverse events but indicated that more research was explain the success of the new handoff process in our
needed to identify ways to improve the handoff process SICU. Training on how to perform postoperative hand-
and determine its effects. In addition, the authors noted off by itself is unlikely to have changed behaviors and
that most studies in this area focus on pediatric patients improved patient safety. According to human factors
undergoing cardiac surgery and thus typically involve science, problems are fixed not by teaching people
small clinical teams and patients with a high level of how to modify their behaviors but rather by modifying
acuity. In contrast, our study was conducted in an adult the design of the system to better aid people.15 The inter-
mixed SICU; thus, given that adult ICUs outnumber vention changed the system by creating a new structure
pediatric units, our study is likely to be generalizable to for the postoperative handoff. Roles were assigned,
a larger patient population. tools were created, and visual cues were provided that
The literature includes several articles on postopera- redesigned the framework in which postoperative hand-
tive patient handoff in adult mixed ICUs. One study off occurred.

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 Human factors engineering is concerned with the The strength of buy-in from each group in the multi-
interaction between people and their environment disciplinary team will also affect the impact of the change.
and how changes in this interaction can contribute to In our SICU, the nurses and nurse practitioners became
improvements in performance, safety, and quality.16 important catalysts in the culture change. Their high
Operation Hard Stop changed the organizational level of buy-in, physical presence on the unit, and conti-
culture and climate surrounding patient safety. For nuity over time increased the impact of the intervention,
instance, after the intervention, the nurses were more promoting the initiative’s success.
likely to report feeling included in the handoff process Another factor that may affect the ability to change
and able to stop performing their routine or urgent the culture of a unit is the amount of staff experience.
activities in order to participate in handoff. Thus, the The specific impact of more or less experience on satis-
organizational culture had changed to allow nurses to faction with a new handoff process is unclear. On the
feel that they could participate and that their participa- one hand, a nurse with less experience might be more
tion was valued. amenable to a change in culture because of greater flexi-
A consensus has emerged that although many facility- bility and openness to different approaches to providing
driven factors can affect culture change, the factors that care. On the other hand, a more experienced nurse might
most contribute to patient safety are leadership support, have a greater investment in the unit and therefore be
communication, and teamwork.17 In our institution, it more committed to practice improvements. In our study,
is unlikely that change would have occurred without the we did not find statistically significant differences in
buy-in of all members of the multidisciplinary group and nurse perceptions of handoff by years of experience, but
their persistence in working toward a culture change the small sample size may have affected this result.
regarding what was expected postoperatively. Thus, rep- Although the results of our study indicate a perceived
lication of this intervention at other sites should take a improvement in patient safety, this is only a perception:
multidisciplinary approach to design and implementa- we did not collect patient outcome data, such as number
tion in order to have the best chance of success. of days receiving mechanical ventilation, length of stay,
or mortality rate. Even if these data were collected, it
Limitations would be difficult to determine whether any improve-
The culture in the SICU at our institution was condu- ments in outcomes were due solely to the intervention.
cive to the success of Operation Hard Stop. However, For the first 2 months of the intervention, an audit
the current cultures at other institutions may limit the was conducted to ensure adherence to the formalized
amount of change in behaviors and patient safety that postoperative handoff process. The unit clerks completed
can be achieved. Moreover, the need for change may a daily log that listed each incident of a patient’s return
vary. For example, in our study the anesthesia team from the OR and whether a written handoff record was
results did not show significant improvement because found in the bedside chart. Reeducation was provided
the nurses were already satisfied with the handoff from whenever possible. No cumulative data were collected
this team before the intervention, whereas the surgical on adherence to the process or on nurse perceptions of
team handoff had more room for improvement. the intervention at that time. Such process outcome
In evaluating the results of the intervention, this study data could have provided another helpful perspective
focused on the perceptions of nurses, without taking on potential barriers to the intervention’s success.
into account the impressions of the other members of As the use of a formalized postoperative handoff
the multidisciplinary group. Given that our SICU includes process expands to other locations in the hospital, future
only 7 nurse practitioners and that they conducted the evaluations of the effectiveness of the intervention may
survey, it is possible that the results reflect bias toward include direct observation of the verbal handoffs or
the success of the initiative. We focused on measuring an audit of the written handoff tool. Such measures
the perceptions of nurses rather than physicians in part could help determine the amount of change in the
because in an academic medical center, physician train- verbal and written handoff before and after the inter-
ees come and go on a monthly basis, whereas the nursing vention. Examining patient outcome data is an espe-
staff is relatively consistent over time. cially important task for future assessment. All of these

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evaluation techniques will require more time and per- 12. Segall N, Bonifacio AS, Schroeder RA, et al. Can we make postoperative
patient handovers safer? A systematic review of the literature. Anesth
sonnel to support project expansion. Analg. 2012;115(1):102-115.
13. Segall N, Bonifacio AS, Barbeito A, et al. Operating room-to-ICU patient
handovers: a multidisciplinary human-centered design approach. Jt Comm
Conclusion J Qual Patient Saf. 2016;42(9):400-409.
14. Lane-Fall MB, Pascual JL, Massa S, et al. Developing a standardized hand-
Patient safety depends on the effective coordination off process for operating room–to-ICU transitions: multidisciplinary
clinician perspectives from the handoffs and transitions in critical care
of care between the multidisciplinary HCP teams. The (HATRICC) study. Jt Comm J Qual Patient Saf. 2018;44(9):514-525.
implementation of a formalized HCP handoff process 15. Russ AL, Fairbanks RJ, Karsh B, Militello LG, Saleem JJ, Wears RL. The
science of human factors: separating fact from fiction. BML Qual Saf.
increases nurses’ perception of safety and improves the 2013;22(1):802-808.
transmission of information between HCPs. Well-designed 16. Carayon P, Wetterneck TB, Rivera-Rodriguez J, et al. Human factor sys-
tems approach to healthcare quality and patient safety. Appl Ergon.
handoffs that ensure good team communication and 2014;45(1):14-25.
17. Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient
individualized patient management are supported by safety in healthcare organizations. BMJ Qual Saf. 2003;12(suppl 2):
evidence-based research and should become the stan- ii17-ii23.

dard of care. CCN

Financial Disclosures
None reported.

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See also
To learn more communication in the critical care setting, read
“Improving Communication Between Surgery and Critical Care
Teams: Beyond the Handover” by Turner et al in the American
Journal of Critical Care, September 2018;27:392-397. Available at
www.ajcconline.org.

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Improving Postoperative Handoff in a Surgical Intensive Care Unit
Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, Stephanie Katzer, Meredith Huffines, Cindy Dove,
Megan Anders, Samuel M. Galvagno and Samuel A. Tisherman
Crit Care Nurse 2019;39 e13-e21 10.4037/ccn2019523
©2019 American Association of Critical-Care Nurses
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