OR to ICU handoff: theory of change model for sustainable change in behavior

Tahira Faiz, Bushra Saeed, Sadaqat Ali, Qalab Abbas, Mahim Malik

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Handoff in cardiac intensive care units has been associated with improved outcomes. We aimed to determine whether a standardized protocol for handover could be implemented using the “theory of change” model by education, introduction of a checklist, and developing feedback mechanisms, measured by better knowledge transfer and bedside care provider satisfaction. Methods: A theory of change model was developed and implemented to introduce a teamwork-driven handover process. A standardized checklist was made available at every bedside. A preintervention assessment of patient handovers was obtained by direct observation using a standardized checklist. The same checklist was used for assessment after implementation. A survey was conducted to measure intensive care unit staff perception and satisfaction with the handover process. Results: After implementation, the standardized handover process was employed in 53 of 60 patient transfers (88.3% compliance): 49 preintervention and 29 postintervention observations were performed. Postimplementation, critical knowledge omissions (total score of 25) decreased from a median of 10 (range 4–17) to 0 (range 0–4; p < 0.001). At 6 months, knowledge omission scores improved to a median of 0 (range 0–1; p < 0.001); and 96% (24/25) of staff reported improvement in the quality of information transfer, and 100% reported improvement in overall team work. Conclusion: Implementation of a standardized patient handover process improved the quality of knowledge transfer and overall staff satisfaction. The theory of change model is a unique and highly effective tool to implement and sustain behavior change.

Original languageEnglish
Pages (from-to)452-458
Number of pages7
JournalAsian Cardiovascular and Thoracic Annals
Issue number6
Publication statusPublished - 1 Jul 2019


  • Communication
  • continuity of patient care
  • intensive care units
  • patient care team
  • patient transfer
  • pediatric
  • quality improvement


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