Cultura

Standardizing Nurse-to-Physician Communication During Critical Care Transitions

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Abdullatif Meshal Almalawi, Adel Misfer Alzhrani, Nor Mohammad Omar Naseeb, Najah Hassan Abdullah Bashir

Abstract

Critical care transitions represent high-stakes clinical microsystems where vulnerable, hemodynamically unstable patients are transferred across clinical domains, shift changes, and interprofessional boundaries. Interprofessional communication failures—particularly between critical care nurses and physicians—remain a primary root cause of preventable adverse events, diagnostic delays, therapeutic misadventures, and prolonged intensive care unit (ICU) length of stay. While standardized communication protocols (e.g., SBAR, I-PASS) have gained widespread endorsement from patient safety organizations, their implementation in high-acuity critical care handoffs is frequently compromised by steep professional authority gradients, cognitive overload, environmental disruptions, and electronic health record (EHR) fragmentation. This comprehensive review synthesizes pre-2024 literature evaluating the structural architecture, sociotechnical dynamics, and patient safety outcomes of standardized nurse-to-physician communication during critical care transfers. Specifically, this paper examines the epidemiology of handoff errors; analyzes differential communication dynamics across Emergency Department-to-ICU (ED-to-ICU), Operating Room-to-ICU (OR-to-ICU), intra-ICU shift transfers, and step-down transitions; evaluates theoretical frameworks including Cognitive Load Theory, Situation Awareness, and Resilient Health Care; and outlines quality improvement methodologies for sustainable workflow integration. Evidence demonstrates that structured, closed-loop interprofessional handoffs significantly reduce information omission rates, prevent medication misadventures, shorten ICU length of stay, and improve team cohesion. However, achieving sustained clinical adoption requires moving beyond static checklists toward sociotechnical, context-sensitive, human-centered handoff protocols backed by strong organizational psychological safety and EHR integration.

Keywords : Critical care nursing, Interprofessional communication, Handoff standardization, SBAR, I-PASS, Patient safety, Critical transitions, Cognitive load theory..
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty