Improving clinical handover of critically ill or injured children from the Emergency Department to the Children’s Intensive Care Unit

Ms Jane Cichero1, Mr  Paul Hunstead2, Dr Puneet  Singh3, Dr Christopher  Johansson4, Ms Wendy  Stephen5, Erica  Faust6, Ms Clare  Ells7, Ms Yvonne  Janiszewski8

1Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 2Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 3Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 4Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 5Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 6Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 7Sydney Children’s Hospitals Network, Randwick, Randwick, Australia, 8Sydney Children’s Hospitals Network, Randwick, Randwick, Australia

A quality improvement project was undertaken in a paediatric tertiary referral hospital to evaluate the effectiveness of the handover process of a critically ill or injured child from the emergency department (ED) to the children’s intensive care unit (CICU). There is extensive literature regarding the significant benefit of effective Clinical Handover on patient safety 2, 3. This project aimed to evaluate effectiveness of the current handover process, identify barriers to effective handover, and implement changes to standardise the transfer process.

Surveys and focus groups were conducted to identify the barriers and levers of the clinical handover process. Using this data, a standardised patient transfer process incorporating the ISBAR principles was developed. The finalized format included a guideline and a checklist.

The process and checklist was then tested in a simulated environment by the project team. Further refinement of the guideline and tool post simulation was enabled through video review and reflection of the simulation.

The video was utilised to educate a group of clinicians from ED and CICU on the new guideline and checklist and a subsequent in situ simulation was conducted with this group. Feedback on the guideline and checklist following the simulation was collected and edits made accordingly.

An audit tool was developed to evaluate the handover process prior to and post implementation. Data to date has shown a measurable improvement in a clinical handover of children to CICU.

The opportunity to evaluate and refine the checklist in simulated settings has enabled a smooth roll out of a tool that meets the project aim of improving patient safety in the clinical handover process. The innovation of utilising the video to facilitate implementation along with re-enforcement of the use of the checklist in regular simulated scenarios has led to greater uptake and subsequently improved clinical handover and patient care.


Jane Cichero has been a Paediatric Nurse Educator since 2002. Jane holds a Graduate Certificate of Paediatrics, Paediatric Critical Care and a Graduate Diploma of Clinical Teaching. Jane has extensive experience in general paediatric nursing, paediatric intensive care and paediatric emergency nursing. Her passion for education incorporates a passion for simulation. Jane completed the Harvard Medical Simulation as a Teaching Tool Instructor Course in 2011 and has continued to develop skills and knowledge in the world of simulation. Her current role as Nurse Lead for Simulation in the Emergency Department at Sydney Children’s Hospital, Randwick enables her to promote and utilise simulation in many aspects of multidisciplinary education and quality and safety in emergency care.