Published 2024-09-15
Keywords
- Critical care nursing, Interprofessional communication, Handoff standardization, SBAR, I-PASS, Patient safety, Critical transitions, Cognitive load theory.
This work is licensed under a Creative Commons Attribution 4.0 International License.
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.