When a patient leaves the operating theatre and arrives in the intensive care unit (ICU), it marks a critical transition — one that can influence outcomes, safety, and continuity of care. Yet, despite Australia’s sophisticated systems and highly trained staff, the handover between theatre and ICU remains one of the most vulnerable points in the perioperative journey.

These transitions are high-stakes. Patients are often sedated, ventilated, haemodynamically unstable, or recovering from complex surgical procedures. The operating team may be handing over to staff unfamiliar with the case, while the ICU team is preparing to assume 24/7 responsibility for a patient they’ve never met. Any missed information, unclear priorities, or breakdown in communication can have serious consequences.

Why the Gaps Happen

Research shows that handover failures are rarely due to lack of skill or intent. Instead, they tend to result from systemic and structural issues, such as:

• Time pressure in busy surgical lists
• Interruptions during transfer or report
• Lack of a shared handover protocol
• Unclear roles: Who leads the handover — the anaesthetist, the surgeon, or both?
• Missing documentation or poorly structured notes

Australian studies have shown that theatre-to-ICU handovers without structured tools often miss crucial details — such as medication records, fluid balance, or airway notes — putting pressure on ICU staff to fill these gaps upon patient arrival.

What Should Be Handed Over?

There is broad consensus that safe handover must include:

• Surgical procedure performed
• Anaesthetic course (agents used, complications, airway notes)
• Intraoperative events (bleeding, instability, unexpected findings)
• Postoperative plans (ventilation, analgesia, sedation weaning)
• Lines, drains, catheters in situ
• Blood loss and fluid balance
• Any specific concerns or watchpoints for the next 6–12 hours

But in practice, not all this information is conveyed — or it may be shared in a disorganised or rushed manner. The result? Delays in medication, duplicate tests, preventable deterioration, and avoidable distress for both patients and staff.

ICU Nurses: The Last Line of Defence

ICU nurses often serve as the final safety net, piecing together incomplete handovers while stabilising the patient. But this reactive mode is unsustainable and introduces risk.

As one senior ICU nurse at a Melbourne hospital put it:

“You have to chase information at the worst possible time — while trying to manage a fresh post-op admission with lines everywhere and vitals on the edge.”

A standardised, structured approach to handover could reduce this burden and improve both care and confidence.

Solutions in Action

Several Australian health services have introduced structured handover protocols, including:

• ISBAR (Identify–Situation–Background–Assessment–Recommendation) templates
• Written summary handover sheets provided by theatre staff
• Face-to-face, multidisciplinary handovers at the bedside
• Time-outs to prevent interruptions during transfer

Some ICUs have also introduced visual handover boards, clearly displaying key parameters such as ventilation settings, pain management plans, and fluid balance. While formal outcome data remains limited, Australian pilot studies and local audits report improved completeness, fewer missed details, and greater staff satisfaction with the handover process.

A single-site quality improvement study conducted in an Australian ICU observed 32 theatre- to-ICU transfers. After implementing a bedside, multidisciplinary “hands-off” handover model led by the anaesthetist, researchers found improved communication quality and greater team engagement. While checklist use was inconsistent, ICU nurses often prompted for missing information themselves, underscoring the importance of real-time, face-to-face interaction at the bedside.

Training and Culture Matter

Communication skills are often assumed, but not always taught. Simulation-based training, joint theatre-ICU debriefs, and peer shadowing can help improve not only what is handed over, but how.

The cultural tone is equally important. Handover must be a shared responsibility, not a task to be delegated. Theatre and ICU teams must see each other as partners in a shared mission: safe, seamless patient care.

Final Thoughts

In the high-stakes environment of critical care, communication is not an add-on — it’s a clinical skill as vital as airway management or drug calculation. Closing the gaps between theatre and ICU requires clear protocols, shared accountability, and a commitment to speaking up when things are unclear. Because in those handover moments, patients may be silent — but their safety depends on what’s said, and what’s heard.