For further information on this project, please contact the following staff who were previously part of the West Metro Vaccination Program:
- Kimberly Brown – Clinical Nurse Consultant, ICU Liaison Service
I would like to acknowledge the Peri-operative and Critical Care Division for supporting this initiative, as well as the nursing and medical staff of FICU & SICU for participating in data collection and embracing a change in handover process.
In September 2019, there was a clinical incident involving a ventilated patient and communication of handover in the ICU, resulting in mortality. On review, it was found that WH does not have an agreed on, or standardised handover process for the transfer of care to ICU for critically ill patients.
There were variable processes for handover and transfer of care for a patient arriving to ICU, depending on the WH site, admission source, who is present during clinical handover, and where that handover occurs.
The handover tool to be implemented focuses on a four step process represented by the acronym, COLD: Connect, Observe, Listen, and Delegate.
The aim was to implement the COLD handover tool into both Intensive Care Units at Western Health, aiming for 100% of patients admitted to the ICU, handed over using the COLD approach.
To further understand the extent of the variation in handover and the causes of it, a number of diagnostic processes were utilised. These included data analysis through an audit tool, process mapping, and staff consultation. There was no funding provided for this project, with in-house resources utilised.
The COLD handover process has been successfully implemented at both Footscray and Sunshine ICU as everyday practice, measured by both direct and indirect audits. Post-implementation, 95% of all handovers audited followed all steps of the COLD process in order and there was an overall improvement in all key metrics.
The COLD handover process is a systematic method used to provide a safe, and effective handover for critically ill patients. The key elements of connect, observe, listen, and delegate, provide a necessary structured approach. The project yielded learnings in other areas outside the immediate scope of this project, which can be addressed in future projects. This includes handovers of ICU patients that take place outside of the ICU Unit, and improving checking of patient ID processes.