1
|
Yip JWC. A Discourse Study on Handover Communication Among Care Providers in a Residential Care Home for Persons with Intellectual Disabilities. HEALTH COMMUNICATION 2024; 39:216-228. [PMID: 36593224 DOI: 10.1080/10410236.2022.2163105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Abundant research has focused on handovers among nurses and/or doctors in hospitals; far less is known about handovers among care providers in non-clinical contexts, such as care homes for the elderly or the disabled. Focusing on handovers in a residential care home for persons with intellectual disabilities (RCHID), this study argues that handover communication in non-clinical settings is equally important. Ineffective handovers can lead to the deterioration of the residents' health conditions, chaotic situations and even injuries to both care providers and care recipients. Staff in RCHIDs rely heavily on handover communication to obtain information about the residents' needs and to offer appropriate care services. Combining discourse analysis with interactional sociolinguistics, this study analyzes written and spoken discourses involved in handover communication among care providers in a typical RCHID in Hong Kong to investigate what and how communicative functions were achieved through the participants' language use. The data were collected by convenience sampling, including handwritten notes and handover recordings of twelve sessions. Then a group interview of seven care providers was conducted to obtain supplementary data. Findings suggest that handover communication includes informational and interpersonal functions. While information delivery is the main purpose, care providers also establish relationships with one another through small talk about care home residents. The results suggest potential drawbacks of the handovers, including illegible notes, inconsistent information collection, and low interactivity. This study proposes a model that elucidates the correlation between discourse, handover communication and healthcare services, and suggests strategies to enhance such communication.
Collapse
Affiliation(s)
- Jesse W C Yip
- Department of Linguistics and Modern Language Studies, The Education University of Hong Kong
| |
Collapse
|
2
|
Weigl M, Heinrich M, Rivas J, Bergmann F, Kurz M, Silbereisen C, Dieterich HJ, Kleine B, Riek S, Olivieri M, Hoffmann F, Lieftüchter V. Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions. Eur J Pediatr 2023; 182:5637-5647. [PMID: 37819421 PMCID: PMC10746584 DOI: 10.1007/s00431-023-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.
Collapse
Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital, Bonn, 53127, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martina Heinrich
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Rivas
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kurz
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Clemens Silbereisen
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Hans-Juergen Dieterich
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Beate Kleine
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Riek
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Victoria Lieftüchter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
3
|
Vetter L, Camenzind E. [Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals]. Pflege 2023; 36:87-94. [PMID: 35301868 DOI: 10.1024/1012-5302/a000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals Abstract: Background: Patient handovers carry a risk of inadequate or missing communication of important information that can jeopardize patient safety. To increase patient safety, protocols for processes and contents of a structured patient handover were created. Aim: To assess the current status of patient handovers from anaesthesia staff to recovery room nurses. Method: After a literature search an observation protocol for patient handovers according to the SBAR concept (von Dossow & Zwißler, 2016) was developed. Using this checklist, non-participant observations were conducted in three Swiss hospitals and evaluated with statistical analysis. Results: A total of 98 observations were made. The report receiving person felt integrated into the handover and received the necessary information. Deficiencies in patient identification and a joint control of lines after surgical interventions could be identified. The subjectively rated quality of patient handover did not differ between the three hospitals (X2(2)=,927, p=,629) and also not according to the time of day (X2(2)=3,604, p=,216). There was also no difference between the subjective quality of the handover and the delivering professional group (X2(3)=4,507, p=,212). Conclusions: The subjective quality of patient handover did not differ between the three hospitals. However, the patient handover protocols need to be adapted to ensure that patient identification and a joint assessment including control of lines and drains are performed.
Collapse
Affiliation(s)
- Luzia Vetter
- Klinik für Anästhesie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Elena Camenzind
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Bern, Schweiz
| |
Collapse
|
4
|
Morán-Pozo C, Luna-Castaño P. Shift change handovers between nurses in Critical Care Units. ENFERMERIA INTENSIVA 2023:S2529-9840(23)00012-5. [PMID: 36934076 DOI: 10.1016/j.enfie.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 03/18/2023]
Abstract
AIM To know the characteristics of the handover performed by nurses working in Critical Care Units in Spain. METHODS Descriptive and cross-sectional study, whose population was nurses working in Critical Care Units in Spain. An ad hoc questionnaire was used to explore the characteristics of the process, the training received, the information forgotten and the influence of this activity on patient care. The questionnaire was online and dissemination was done through social networks. The sample was selected by convenience. A descriptive analysis was performed according to the nature of the variables and comparison of groups through ANOVA with R software version 4.0.3 (R Project for Statistical Computing). RESULTS The sample was 420 nurses. Most of them answered that (79,5%) perform this activity in an individual way, from outgoing nurse to incoming nurse. Location varied according to the size of the unit (p<0,05). Interdisciplinary handover was rare (p<0.05). In the last month, with regard to the time of data collection, 29,5% had to contact the unit due to forgetting relevant information, using WhatsApp as the first channel to transmit this information. CONCLUSIONS There is a lack of standardization in the handoff between shifts, in terms of the physical space where it is done, tools to structure the information, participation of other professionals and the use of unofficial communication channels to contact for omitted information during the handover. Shift change was identified as a vital process to ensure continuity of care and patient safety, so further researchs are important for patients handoffs.
Collapse
Affiliation(s)
- C Morán-Pozo
- Responsable de Investigación de Enfermería, Hospital Central Cruz Roja, Madrid, Spain.
| | - P Luna-Castaño
- Supervisora de Investigación en Cuidados, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
5
|
Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM). BMC Health Serv Res 2022; 22:1553. [PMID: 36536410 PMCID: PMC9764555 DOI: 10.1186/s12913-022-08877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Norway has prioritized health services according to the principle of "severity of conditions", where waiting time reflects patients' medical urgency. We aim to investigate if the "severity-of-condition" principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients' diagnoses and symptom severity at the start of treatment and the corresponding waiting time. METHODS The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with patients' diagnoses to identify patients' needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times. RESULTS Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders. CONCLUSION Overall, patients waited in accordance with the "severity of condition" principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.
Collapse
|
6
|
Staal J, Speelman M, Brand R, Alsma J, Zwaan L. Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study. BMC MEDICAL EDUCATION 2022; 22:256. [PMID: 35395938 PMCID: PMC8991944 DOI: 10.1186/s12909-022-03325-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians' diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when referring a patient to secondary care. However, it remains unclear via which underlying processes this practice can impact diagnostic performance. This study therefore examined the effect of a diagnostic suggestion in a GP's referral letter to the emergency department on the diagnostic performance of medical interns. METHODS Medical interns diagnosed six clinical cases formatted as GP referral letters in a randomized within-subjects experiment. They diagnosed two referral letters stating a main complaint without a diagnostic suggestion (control), two stating a correct suggestion, and two stating an incorrect suggestion. The referral question and case order were randomized. We analysed the effect of the referral question on interns' diagnostic accuracy, number of differential diagnoses, confidence, and time taken to diagnose. RESULTS Forty-four medical interns participated. Interns considered more diagnoses in their differential without a suggested diagnosis (M = 1.85, SD = 1.09) than with a suggested diagnosis, independent of whether this suggestion was correct (M = 1.52, SD = 0.96, d = 0.32) or incorrect ((M = 1.42, SD = 0.97, d = 0.41), χ2(2) =7.6, p = 0.022). The diagnostic suggestion did not influence diagnostic accuracy (χ2(2) = 1.446, p = 0.486), confidence, (χ2(2) = 0.058, p = 0.971) or time to diagnose (χ2(2) = 3.128, p = 0.209). CONCLUSIONS A diagnostic suggestion in a GPs referral letter did not influence subsequent diagnostic accuracy, confidence, or time to diagnose for medical interns. However, a correct or incorrect suggestion reduced the number of diagnoses considered. It is important for healthcare providers and teachers to be aware of this phenomenon, as fostering a broad differential could support learning. Future research is necessary to examine whether these findings generalize to other healthcare workers, such as more experienced specialists or triage nurses, whose decisions might affect the diagnostic process later on. TRIAL REGISTRATION The study protocol was preregistered and is available online at Open Science Framework ( https://osf.io/7de5g ).
Collapse
Affiliation(s)
- J Staal
- Erasmus University Medical Center Rotterdam, Institute of Medical Education Research, Rotterdam, the Netherlands.
| | - M Speelman
- Erasmus University Medical Center Rotterdam, Institute of Medical Education Research, Rotterdam, the Netherlands
- Faculty of Medical Sciences, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R Brand
- Intensive Care Unit, Haaglanden Medical Center Den Haag, The Hague, the Netherlands
| | - J Alsma
- Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L Zwaan
- Erasmus University Medical Center Rotterdam, Institute of Medical Education Research, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Wolinska JM, Lapidus-Krol E, Fallon EM, Kolivoshka Y, Fecteau A. I-PASS enhances effectiveness and accuracy of hand-off for pediatric general surgery patients. J Pediatr Surg 2022; 57:598-603. [PMID: 34911653 DOI: 10.1016/j.jpedsurg.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND I-PASS is a validated and standardized hand-off protocol shown to reduce medical error and improve hand-off efficiency in the pediatric medical population. Our aim was to evaluate the feasibility, effectiveness, accuracy and resident satisfaction of implementing I-PASS on a pediatric surgery service. METHODS A prospective intervention Quality Improvement (QI approved) study was utilized to evaluate resident written and verbal hand-offs before and after implementation of I-PASS on a pediatric surgery service at a tertiary center. Anonymous surveys were completed by residents following each observation. Results were analyzed using T or Mann-Whitney U Tests and Chi Square. RESULTS A total of 49 written tools and 50 verbal hand-offs were compared pre-and post I-PASS implementation. With I-PASS, increased written accuracy was observed in the documentation of the patient summary (p < 0.05). Accuracy in the verbal hand-off of illness severity, patient summary, contingency plan, action list and synthesis also improved (p < 0.05); but duration of hand-off increased (p < 0.01). Post implementation surveys of residents demonstrated an increased understanding of patient management (p < 0.05). CONCLUSION Implementing I-PASS on a pediatric surgery service with modifications catered to surgical patients, improved the effectiveness and accuracy of written and verbal patient hand-offs and increased provider satisfaction and preparedness. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Justyna M Wolinska
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 1526A Hill Wing, Toronto, ON M5G 1×8, Canada; Division of General and Thoracic Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 1526A Hill Wing, Toronto, ON M5G 1×8, Canada.
| | - Erica M Fallon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 1526A Hill Wing, Toronto, ON M5G 1×8, Canada
| | - Yuriy Kolivoshka
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 1526A Hill Wing, Toronto, ON M5G 1×8, Canada
| | - Annie Fecteau
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 1526A Hill Wing, Toronto, ON M5G 1×8, Canada
| |
Collapse
|
8
|
Halverson CC, Scott Tilley D. Nursing surveillance: A concept analysis. Nurs Forum 2022; 57:454-460. [PMID: 35187679 DOI: 10.1111/nuf.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
AIM To provide a framework to assess and evaluate nursing surveillance of patients. BACKGROUND The Nursing Interventions Classifications define surveillance as the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making and is essential for improving patient safety. DATA SOURCE The existing literature was searched using CINAHL, OVID, EmCare, and 11 ScienceDirect databases. METHODS The Walker and Avant method was used to analyze the concept of surveillance. RESULTS Technology that facilitates surveillance in the community is ubiquitous in acute care settings. Nurses caring for patients use a tremendous volume of patient data to inform their clinical decision-making. Five attributes are associated with nursing surveillance: systematic process, pattern recognition, coordinated communication, the anticipation of problems of instability, and decision making. Surveillance is dynamic and extends over time. Antecedents to nursing surveillance include sufficient nurse education, nurse expertise, nurse staffing, as well as an organizational culture that supports nursing surveillance. When nursing surveillance is present, patient safety is enhanced and adverse events that harm patients are reduced. The concept of nursing surveillance is complex and defies empirical measurement, though it is possible to measure the attributes and outcomes. CONCLUSIONS Nursing surveillance is essential to the safe management of complex patient cases. Surveillance is more than monitoring or simple patient observation. Monitoring is an essential part of surveillance but incorporating the critical attributes of surveillance lead to improved patient outcomes.
Collapse
|
9
|
Kovoor JG, Gupta AK, Ovenden CD, Hewitt JN, Asokan GP, Maddern GJ. Does the hospital system enable surgical residents to practice evidence-based surgery? ANZ J Surg 2021; 91:1968-1969. [PMID: 34665500 DOI: 10.1111/ans.17067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Discipline of Surgery, Women's and Children's Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Gayatri P Asokan
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| |
Collapse
|
10
|
How can communication to GPs at hospital discharge be improved? A systems approach. BJGP Open 2021; 6:BJGPO.2021.0148. [PMID: 34620598 PMCID: PMC8958742 DOI: 10.3399/bjgpo.2021.0148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work. Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group. Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
Collapse
|
11
|
Jaulin F, Lopes T, Martin F. Standardised handover process with checklist improves quality and safety of care in the postanaesthesia care unit: the Postanaesthesia Team Handover trial. Br J Anaesth 2021; 127:962-970. [PMID: 34364652 DOI: 10.1016/j.bja.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/19/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Miscommunication is a leading cause of preventable incidents in healthcare. A number of checklists have been created in an attempt to improve patient outcomes with only a small impact. However, the 2009 WHO Surgical Safety Checklist demonstrated benefits in terms of reduced morbidity and mortality. Our aim was to determine whether use of a Postanaesthesia Team Handover (PATH) checklist would reduce hypoxaemic events in the postanaesthesia care unit (PACU). METHODS This single-centre, prospective, pre-/post-implementation study was conducted between February 2019 and July 2020 in the PACU of Versailles Private Hospital, Paris, France. Pre-PATH implementation data were collected for 294 consecutive adult patients (≥18 yr old) admitted to the PACU and post-PATH implementation data were collected for 293 consecutive patients. The primary outcome was the rate of hypoxaemic events post-surgery during PACU stay. RESULTS The rates of hypoxaemic events were 4.1% (11/267 [95% confidence interval {CI}: 2.3-7.2%]) before the PATH checklist was introduced and 0.8% (2/266 [95% CI: 0.2-2.7%]) after. Patients in the PATH group were 5.6 times (odds ratio [OR] [95% CI: 1.3-33.6], P=0.041) less likely to have a hypoxaemic event than those in the control group. The handover process in the PATH checklist group also had significantly less interruptions (38.6% control vs 20.7% PATH; OR=2.5 [95% CI: 1.7-3.7]; P<0.0001). CONCLUSIONS Implementation of the PATH checklist in adult patients post-surgery was associated with a reduction in the rate of hypoxaemic events in the PACU. These findings support standardisation of the handover process with checklists following anaesthesia and surgery. CLINICAL TRIAL REGISTRATION NCT03972423.
Collapse
Affiliation(s)
- François Jaulin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France
| | - Thomas Lopes
- Versailles Private Hospital, Ramsay Santé, Paris, France
| | - Frederic Martin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France; Versailles Private Hospital, Ramsay Santé, Paris, France.
| |
Collapse
|
12
|
Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J. Clinical handover and handoff in healthcare: a systematic review of systematic reviews. Int J Qual Health Care 2021; 33:6039082. [PMID: 33325520 DOI: 10.1093/intqhc/mzaa170] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 11/03/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this systematic review is to appraise and summarize existing literature on clinical handover. DATA SOURCES We searched EMBASE, MEDLINE, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews. STUDY SELECTION Included articles were reviewed independently by the review team. DATA EXTRACTION The review team extracted data under the following headers: author(s), year of publication, journal, scope, search strategy, number of studies included, type of studies included, study quality assessment, used definition of handover, healthcare setting, outcomes measured, findings and finally some comments or remarks. RESULTS OF DATA SYNTHESIS First, research indicates that poor handover is associated with multiple potential hazards such as lack of availability of required equipment for patients, information omissions, diagnosis errors, treatment errors, disposition errors and treatment delays. Second, our systematic review indicates that no single tool arises as best for any particular specialty or use to evaluate the handover process. Third, there is little evidence delineating what constitutes best handoff practices. Most efforts facilitated the coordination of care and communication between healthcare professionals using electronic tools or a standardized form. Fourth, our review indicates that the principal teaching methods are role-playing and simulation, which may result in better knowledge transfer to the work environment, better health and patients' well-being. CONCLUSIONS This review emphasizes the importance of staff education (including simulation-based and team training), non-technical skills and the implementation process of clinical handover in healthcare settings.
Collapse
Affiliation(s)
- Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Dorien Ulenaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Joep Grosemans
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium.,Faculty of Healthcare, PXL University of Applied Sciences and Arts, Elfde-Liniestraat 24, Hasselt, Province of Limburg 3500 Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium.,Faculty of Healthcare, PXL University of Applied Sciences and Arts, Elfde-Liniestraat 24, Hasselt, Province of Limburg 3500 Belgium
| |
Collapse
|
13
|
Hada A, Coyer F. Shift-to-shift nursing handover interventions associated with improved inpatient outcomes-Falls, pressure injuries and medication administration errors: An integrative review. Nurs Health Sci 2021; 23:337-351. [PMID: 33665950 DOI: 10.1111/nhs.12825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
The aim of this integrative review was to identify which nursing handover interventions were associated with improved patient outcomes, specifically patients' falls, pressure injuries and medication administration errors, in the hospital setting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the review. A systematic search of seven electronic databases was conducted, and retrieved articles were assessed by two independent reviewers. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Eight studies met the inclusion criteria. The findings of this review indicate that improvements in handover communication had a clinically important positive effect on patient outcomes. Across the studies, reductions in falls varied from 9.3 to 80%, pressure injuries from 45 to 75%, and medication errors from 11.1 to greater than 50%. This review highlights that the implementation of bedside nursing handover and the adoption of standardized handover tools to improve nursing handover communication reduce patient adverse events, specifically falls, pressure injuries, and medication errors. These findings should be considered by clinicians to inform their clinical handover practice.
Collapse
Affiliation(s)
- Adriana Hada
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Joint appointment with School of Nursing, Queensland University of Technology and Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
14
|
Developing and Implementing an Ambulatory Postanesthesia Care Unit Hand-Off Tool. J Perianesth Nurs 2021; 36:372-377. [PMID: 33895066 DOI: 10.1016/j.jopan.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this research study was to improve communication and reduce critical information loss between the ambulatory postanesthesia care unit (PACU) and ambulatory surgical center (ASC) nurses by developing, piloting, and evaluating a hand-off communication tool. DESIGN Descriptive study. METHODS This pilot study was conducted in an outpatient surgery unit located at a large Magnet university hospital in New Jersey. Twenty ASC registered nurses (RNs) evaluated the hand-off tool developed for this study. Descriptive statistics were used to analyze the data from the 20 ASC RNs using three Likert-scale questions. FINDINGS Three Likert-style questions guided the rating of this tool. Using correlation analysis, the results support that the tool may be perceived as an instrument that was simultaneously easy to use, helpful, and communicated relevant patient data. The calculation of the reliability coefficient was 0.89. CONCLUSIONS This standardized hand-off tool relayed the pertinent and relevant patient data needed to support handoff from the ambulatory PACU to the ASC. Only ASC RNs rated the tool in this study. A planned second phase will evaluate PACU nurse's perception of the tool.
Collapse
|
15
|
Magnezi R, Gazit I, Bass A, Tal O. Developing a new flexible tool for handover. Int J Qual Health Care 2021; 33:6126441. [PMID: 33528499 PMCID: PMC7928879 DOI: 10.1093/intqhc/mzab022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Transferring medical information among professionals and between shifts is a crucial process, allowing continuity of care and safety, especially for complex patients in life-threatening situations. This process, handover, requires focusing on specific, essential medical information while filtering out redundant and unnecessary details. Objectives To create and implement a tool for handover that would be flexible enough to meet the unique needs of specific departments. Methods We used Plan–Do–Study–Act (PDSA) methodology to prospectively develop, implement, evaluate and reassess a new handover tool in a 900-bed teaching hospital in central Israel. Nurses from 35 departments participated in developing a tool that presents the staff’s viewpoint regarding the most critical information needed for handover. Results A total of 78 nurse managers and 15 doctors (63.7%) completed the questionnaire. Based on exploratory factor analysis, 15 items explained 58.9% of the variance. Four key areas for handover were identified, in addition to basic patient identification: (i) updated clinical status, (ii) medical information, (iii) special clinical treatment and (iv) treatments not yet initiated. Subsequently, a Flexible Handover Structured Tool (FAST) was designed that identifies patients’ needs and is flexible for the specific needs of departments. Revisions based on hands-on experience led to high nurse satisfaction with the new tool in most departments. The FAST format was adopted easily during the COVID-19 pandemic. Conclusion Implementing a new handover tool—FAST—was challenging, but rewarding. Using PDSA methodology enabled continuous monitoring, oversight and adaptive corrections for better implementation of this new handover reporting tool.
Collapse
Affiliation(s)
- Racheli Magnezi
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Inbal Gazit
- Department of Quality and Safety, Asaf Haroffe Medical Center, Rishon-Le-Zion, Israel
| | - Arie Bass
- Department of Quality and Safety, Asaf Haroffe Medical Center, Rishon-Le-Zion, Israel
| | - Orna Tal
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel.,Department of Quality and Safety, Asaf Haroffe Medical Center, Rishon-Le-Zion, Israel.,The Israeli Center for Emerging Technologies in Hospitals (ICET), Assaf Harofe Medical Center, Rishon Le'Zion, Israel
| |
Collapse
|
16
|
Bonaconsa C, Mbamalu O, Mendelson M, Boutall A, Warden C, Rayamajhi S, Pennel T, Hampton M, Joubert I, Tarrant C, Holmes A, Charani E. Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study. BMJ Qual Saf 2021; 30:812-824. [PMID: 33563790 DOI: 10.1136/bmjqs-2020-012372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/03/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making. MATERIALS/METHODS Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach. RESULTS Data were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons. CONCLUSIONS The surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.
Collapse
Affiliation(s)
- Candice Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Oluchi Mbamalu
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Adam Boutall
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Claire Warden
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shreya Rayamajhi
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tim Pennel
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Mark Hampton
- Dr. Matley & Partners Surgical Practice, Cape Town, South Africa
| | - Ivan Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
| | - Esmita Charani
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
| | | |
Collapse
|
17
|
Abstract
AbstractWe present CARE, a context-aware tool for nurses in nursing homes. The system utilises a sensors infrastructure to quantify the behaviour and wellbeing (e.g., activity, mood, social and nurse interactions) of elderly residents. The sensor data is offloaded, processed and analysed in the cloud, to generate daily and long-term summaries of residents’ health. These insights are then presented to nurses via an Android tablet application. We aim to create a tool that can assist nurses and increase their awareness to residents’ needs. We deployed CARE in a local nursing home for two months and evaluated the system through a post-hoc exploratory analysis and interviews with the nurses. The results indicate that CARE can reveal essential insights on the wellbeing of elderly residents and improve the care service. In the discussion, we reflect on our understanding and potential impact of future integrated technology in elderly care environments.
Collapse
|
18
|
Sogstad M, Skinner M. Samhandling og informasjonsflyt når eldre flytter mellom ulike helse- og omsorgstilbud i kommunen. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
19
|
Aase K, Waring J. Crossing boundaries: Establishing a framework for researching quality and safety in care transitions. APPLIED ERGONOMICS 2020; 89:103228. [PMID: 32763449 DOI: 10.1016/j.apergo.2020.103228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the breadth and diversity of research and policies on care transitions, research studies often report similar components that affect the quality and safety of care, including communication across professional groups and care settings, transfer of information, coordination of resources or training of healthcare personnel. In this article, we aim to deepen our understanding of care transitions by proposing a heuristic research framework that takes into account the components and factors influencing the quality and safety of care transitions in diverse settings. METHODOLOGY Using a pragmatic qualitative narrative meta-synthesis of empirically grounded research studies (N = 13) involving 31 researchers from seven countries (Australia, Canada, Denmark, Germany, the Netherlands, Norway and the UK), we conducted a thematic analysis to identify the components analysed in the included studies. We then used these components to create a framework for researching care transitions. RESULTS Our narrative synthesis found that the quality and safety of care transitions are influenced by a range of patient-centred, communicative, collaborative, cultural, competency-based, accountability-based and spatial components. These components are encompassed within a broader set of dimensions that require careful consideration: (1) the conceptualising of the care transition notion, (2) the methodology for researching care transitions, (3) the role of patients and carers in care transitions, (4) the complexity surrounding care transitions, (5) the boundaries intertwined in care transitions and (6) care transition improvement interventions. These six dimensions constitute an analytical framework for planning and conducting research on care transitions in diverse settings. CONCLUSION The proposed six-dimensional framework for researching quality and safety in care transitions offers a roadmap for future practice and policy interventions and provides a starting point for planning and designing future research.
Collapse
Affiliation(s)
- Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, P.O.Box 4600 Forus, 4036, Stavanger, Norway.
| | - Justin Waring
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2RT, United Kingdom.
| |
Collapse
|
20
|
Noh YG, Lee I. Effects of a stepwise handovers ISBARQ programme among nursing college students. Nurs Open 2020; 7:1551-1559. [PMID: 32802376 PMCID: PMC7424453 DOI: 10.1002/nop2.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background Due to a lack of standardized guidelines, it is necessary to verify the effectiveness of educational programmes for nursing students' systematic handover training. Aims This study aimed to develop a stepwise nursing handover programme and to examine its effects on awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education. Design This was a single-group repeated measures ANOVA study. Methods This study was conducted in a nursing department, using a convenience sample of 25 senior nursing students from April 2 to June 22, 2018. The programme was divided into lectures, scenario role-playing and nursing case role-playing. The research questions were analysed using repeated measures ANOVA. Results Awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education gradually increased after each step of the programme. The stepwise nursing handover programme, progressing from low to high levels of learning, can be used to improve the nursing handover system and handover communication ability.
Collapse
Affiliation(s)
- Yoon Goo Noh
- Department of NursingChangwon National UniversityChangwonKorea
| | - Insook Lee
- Department of NursingChangwon National UniversityChangwonKorea
| |
Collapse
|
21
|
Chang YT, Lu PY, Lai CS. Disparity of perspectives between teachers and learners on perioperative teaching and learning. BMC MEDICAL EDUCATION 2020; 20:244. [PMID: 32736559 PMCID: PMC7393732 DOI: 10.1186/s12909-020-02172-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To build a consensus about learning objectives in the operating room, the aim of the study was to evaluate both surgical teacher and learner perspectives on perioperative teaching and learning in Taiwan. METHODS Twelve main technical and non-technical learning objectives in the operating room were evaluated by learners and surgical teachers in Kaohsiung Medical University Hospital. The learners included postgraduate year (PGY) 1-3 residents (junior learner, JL) and PGY 4-7 residents (senior learner, SL). The definition of learning preferences were recommended learning objectives, and learning load was defined as demands of learning preferences. During the survey, surgical teachers evaluated the learning preferences for the learner, and learners evaluated their learning preferences. The learners also evaluated the learning preferences that the surgical teachers should teach. RESULTS Response rate of the questionnaire was 65.4%. A total of 31 learners and 39 surgical teachers completed the survey. The consensus was that the need to increase the learning loads and ethical issues were the learning preferences for SL, and indications, details of procedure, and teamwork were important to both JL and SL. The teachers intended to set specific learning objectives for different learner levels, including (i) indications, details of procedure, teamwork, and postoperative care for both JL and SL; (ii) preoperative preparation, surgical anatomy, and instrument handling for JL (P = 0.022, 0.021 and 0.006); and (iii) surgical technique, independent practice, clinical reasoning, complications, and ethical issues for SL (P = 0.010, < 0.001, < 0.001, 0.001, 0.011). Resident perspective on learning objectives differed between JL and SL, and there was discrepancy between resident's learning as perceived by teachers, particularly in the JL. CONCLUSIONS Our study revealed significant disparity of perspectives between teachers and learners on perioperative teaching and learning. Surgical teachers should set specific learning objectives for different learner levels, since junior and senior residents have different learning preferences even though both scrub in the same case. Effective communication between teachers and learners has the potential to improve learning experience and create a positive environment in the operating room.
Collapse
Affiliation(s)
- Yu-Tang Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peih-Ying Lu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Sheng Lai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
22
|
Frasier LL, Pavuluri Quamme SR, Wiegmann D, Greenberg CC. Evaluation of Intraoperative Hand-Off Frequency, Duration, and Context: A Mixed Methods Analysis. J Surg Res 2020; 256:124-130. [PMID: 32688079 DOI: 10.1016/j.jss.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hand-offs in the operating room contribute to poor communication, reduced team function, and may be poorly coordinated with other activities. Conversely, they may represent a missed opportunity for improved communication. We sought to better understand the coordination and impact of intraoperative hand-offs. METHODS We prospectively audio-video (AV) recorded 10 operations and evaluated intraoperative hand-offs. Data collected included percentage of time team members were absent due to breaks, relationships between hand-offs and intraoperative events (incision, surgical counts), and occurrences of simultaneous hand-offs. We also identified announcement that a hand-off had occurred and anchoring, in which team members not involved in the hand-off participated and provided information. RESULTS Spanning 2919 min of audio-video data, there were 74 hand-offs (range, 4-14 per case) totaling 225.2 min, representing 7.7% of time recorded. Thirty-two (45.1%) hand-offs were interrupted or delayed because of competing activities; eight hand-offs occurred during an instrument or laparotomy pad count. Six cases had simultaneous hand-offs; two cases had two episodes of simultaneous hand-offs. Eight hand-offs included an announcement. Seven included anchoring. Evaluating both temporary and permanent hand-offs, one or more original team members was absent for 40.7% of time recorded and >one team member was absent for 20.5% of time recorded. CONCLUSIONS Intraoperative hand-offs are frequent and not well coordinated with intraoperative events including counts and other hand-offs. Anchoring and announced hand-offs occurred in a small proportion of cases. Future work must focus on optimizing timing, content, and participation in intraoperative hand-offs.
Collapse
Affiliation(s)
- Lane L Frasier
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin
| | - Sudha R Pavuluri Quamme
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin
| | - Douglas Wiegmann
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin; University of Wisconsin-Madison Department of Industrial & Systems Engineering, Madison, Wisconsin
| | - Caprice C Greenberg
- University of Wisconsin-Madison Wisconsin Surgical Outcomes Research (WiSOR) Program, Madison, Wisconsin; University of Wisconsin-Madison Department of Industrial & Systems Engineering, Madison, Wisconsin.
| |
Collapse
|
23
|
Weigl M, Heinrich M, Keil J, Wermelt JZ, Bergmann F, Hubertus J, Hoffmann F. Team performance during postsurgical patient handovers in paediatric care. Eur J Pediatr 2020; 179:587-596. [PMID: 31858255 DOI: 10.1007/s00431-019-03547-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 01/23/2023]
Abstract
Postsurgical handover of paediatric patients from operating rooms to intensive care units is a critical moment. This process is susceptible to errors and inefficiencies particularly if poor teamwork in this multidisciplinary and ad hoc collaboration occurs. Through combining provider- and observer-rated team performance, we aimed to determine agreement levels on team performance and associations with mental demands, disruptions, and stress. An observational and multisource study of provider and concomitant expert-observer ratings was established. In an Academic Paediatric Hospital, we conducted standardized observations of postsurgical handovers to PICU. We applied established observational and self-reported teamwork tools. Nested fixed and mixed models were established to estimate agreement within teams, between providers' and observer's ratings, as well as for estimations between team performance and mental demands, disruptions, and stress outcomes. Thirty-one postsurgical patient handovers were included with overall 109 ratings of involved providers. Provider-perceived team performance was rated high. Within the receiving sub-team, situation awareness was perceived lower compared to the handoff sub-team [F(df = 1) = 4.41, p = .04]. Inter-provider agreement on handover team performance was low for the overall team yet higher within handover sub-teams. We observed that high level of distractions during the handover was associated with inferior team performance rated by observers (B = - 0.72, 95% CI = - 1.44, - 0.01).Conclusion: We observed substantial disagreements on how involved professionals as well as observers rated teamwork during patient transfers. Investigations into paediatric teamwork and particular team-based handovers should carefully consider if concurrent provider and observer assessments are a valid and reliable way to evaluate teamwork in paediatric care. Common handover language should be established and mandatory before jointly evaluating this process. Our findings advocate also that handovers should be performed under low levels of distractions.What is Known:• Efficient teamwork during transfers of critically ill children is fundamental to quality and safety of handover practice.• Postoperative handovers are often performed by ad hoc teams of caregivers with multiple backgrounds and are prone to suboptimal team performance, communication, and information transfer.What is New:• Our provider and expert evaluations of team performance during OR-PICU handovers showed poor agreement for team performance. Our findings challenge previous results drawing upon single source assessments and inform future studies to carefully consider what approach of team performance assessments is required.• We further demonstrate that high levels of disruptions are associated with poor team performance during patient handovers and that efforts to ensure undisrupted handover practices in clinical care are necessary.
Collapse
Affiliation(s)
- Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336, Munich, Germany.
| | - Maria Heinrich
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336, Munich, Germany
| | - Julia Keil
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julius Z Wermelt
- Department of Anaesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
24
|
Spranzi F, Norton C. From handover to takeover: should we consider a new conceptual model of communication? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.3.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline. Design and methods This service evaluation was structured in four stages, each using a different design and research methods. Setting The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK. Findings and conclusion Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events.
Collapse
Affiliation(s)
- Francesca Spranzi
- Risk management support midwife, Imperial College Healthcare, NHS Trust
| | - Christine Norton
- Professor of clinical nursing research, Florence Nightingale faculty of nursing, midwifery and palliative care, King's College London
| |
Collapse
|
25
|
Loefgren Vretare L, Anderzén-Carlsson A. The critical care nurse's perception of handover: A phenomenographic study. Intensive Crit Care Nurs 2020; 58:102807. [PMID: 32044120 DOI: 10.1016/j.iccn.2020.102807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe variations in critical care nurses' perceptions of handover. RESEARCH METHODOLOGY Phenomenographic design using individual interviews for data-collection. SETTING The critical care nurses participating in the study were recruited from critical care units in three hospitals in Sweden. FINDINGS Five descriptive categories were identified: Communication between staff, Opportunity for learning, Patient-centred information gathering as a basis for continuous care, Responsibility for transfers, and Patient safety and quality of care. CONCLUSION Nursing handover is a complex phenomenon, which is understood in various ways. Handover is mediated through communication and marks a shift in responsibility. Handover seems to be related to patient safety and quality of care. There is potential for improvement in the quality of nursing handover in clinical praxis, but further research is needed to determine ways of improving quality of handover.
Collapse
Affiliation(s)
- Linn Loefgren Vretare
- Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; Neonatal Intensive Care Unit, Akademiska Sjukhuset, Uppsala, Sweden
| | - Agneta Anderzén-Carlsson
- Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| |
Collapse
|
26
|
Defining when specialised mental health care is needed: a focus group study. BJGP Open 2020; 4:bjgpopen20X101004. [PMID: 31911418 PMCID: PMC7330180 DOI: 10.3399/bjgpopen20x101004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/29/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Shared understanding between GPs and hospital specialists concerning when patients need specialised mental health care is important to ensure patients receive appropriate care. The large amount of rejected referrals often indicates a lack of such shared understanding. AIM To explore how patient representatives, GPs, and mental health specialists understand 'need for specialised mental health care', meaning that primary care is no longer sufficient. DESIGN & SETTING This qualitative study was conducted in western Norway. The study has a service user-involved research design in which GPs and patient representatives participated in all stages of the research process. METHOD Six semi-structured focus group interviews were conducted. The groups were homogenous as they included only the perspectives of either GPs, mental health specialists, or patient representatives. Data were analysed using thematic analysis. RESULTS The need for specialised mental health care was assessed using two continuums: (a) the patient's level of functioning and symptoms; and (b) characteristics of the healthcare system and the patient's informal support networks. Assessment along these continuums were often overruled by the evaluation of expected usefulness of specialised mental health care. In addition, all participants reported they often adapted their definition of need to fit other stakeholders' interpretations of need. CONCLUSION Evaluation of need for specialised mental health care is complex and depends on several factors. This may explain some of the current challenges that exist with regard to equity and timely access to appropriate healthcare interventions.
Collapse
|
27
|
Tacchini-Jacquier N, de Waele E, Urben P, Turini P, Verloo H. Developing an Evidence-Based Nursing Handover Standard for a Multi-Site Public Hospital in Switzerland: Protocol for a Web-Based, Modified Delphi Study. JMIR Res Protoc 2020; 9:e15910. [PMID: 31913133 PMCID: PMC6996777 DOI: 10.2196/15910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/02/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Poor communication processes create opportunities for errors when caregivers fail to transfer complete and consistent information. Inadequate or nonexistent clinical handovers or failures to transfer information, responsibility, and accountability can have dire consequences for hospitalized patients. Clinical handover is practiced every day, in a multitude of ways, in all health care settings. OBJECTIVE The goal of this study is to build a consensus, evidence-based nursing handover standard for inpatients during shift changes or internal transfers between hospital wards. The study will be based on papers published by Slade et al. METHODS This protocol describes a modified Delphi data-collection survey involving a targeted panel sample of 300 nurse experts. A multi-round survey will select an anonymous panel from a multi-site public hospital in Switzerland. Each survey stage will be described and will build on the previous one. The study will end with a focus group discussion involving a randomly selected panel to explain why items for the evidence-based clinical nursing handover standard were accepted or not accepted. An item must achieve a consensus of ≥70% for inclusion. RESULTS The present study's expected outcome is a consensus-built, evidence-based nursing handover standard for inpatients during shift changes or internal transfers between the wards of a multi-site public hospital in Switzerland. CONCLUSIONS This survey will enable us to develop an evidence-based nursing handover standard for use during shift changes and internal inpatient transfers in a multi-site public hospital in Switzerland. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15910.
Collapse
Affiliation(s)
| | - Els de Waele
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Peter Urben
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Pierre Turini
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
| | - Henk Verloo
- Haute École Spécialisée de Suisse Occidentale, Valais Hospital, Sion, Switzerland
- School of Health Sciences, Haute École Spécialisée de Suisse Occidentale Valais / Wallis University of Applied Sciences of Western Switzerland, Sion, Switzerland
- Service of Old Age Psychiatry, Cery, Lausanne, Switzerland
| |
Collapse
|
28
|
Tacchini-Jacquier N, Hertzog H, Ambord K, Urben P, Turini P, Verloo H. An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study. JMIR Nurs 2020; 3:e17876. [PMID: 34345783 PMCID: PMC8279455 DOI: 10.2196/17876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. OBJECTIVE This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. METHODS We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion. RESULTS The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. CONCLUSIONS This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland.
Collapse
Affiliation(s)
| | | | | | | | | | - Henk Verloo
- Valais Hospital Sion Switzerland
- Haute École Spécialisée Suisse orientale HES-SO Valais / Wallis Sion Switzerland
- Service of Old Age Psychiatry University Hospital of Lausanne Prilly Switzerland
| |
Collapse
|
29
|
Bressan V, Mio M, Palese A. Nursing handovers and patient safety: Findings from an umbrella review. J Adv Nurs 2019; 76:927-938. [DOI: 10.1111/jan.14288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023]
Affiliation(s)
| | - Moreno Mio
- School of Nursing Department of Medical Sciences University of Udine Udine Italy
| | - Alvisa Palese
- Department of Medical Sciences University of Udine Udine Italy
| |
Collapse
|
30
|
Garber A, Nowacki AS, Chaitoff A, Brateanu A, Colbert CY, Bauer SR, Arora Z, Mehdi A, Lam S, Spencer A, Rothberg MB. Frequency, Timing, and Types of Medication Ordering Errors Made by Residents in the Electronic Medical Records Era. South Med J 2019; 112:25-31. [PMID: 30608627 DOI: 10.14423/smj.0000000000000923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe associations between resident level of training, timing of medication orders, and the types of inpatient medication ordering errors made by internal medicine residents. METHODS This study reviewed all inpatient medication orders placed by internal medicine residents at a tertiary care academic medical center from July 2011 to June 2015. Medication order errors were measured by pharmacists' reporting of an error via the electronic medical record during real-time surveillance of orders. Multivariable regression models were constructed to assess associations between resident training level (postgraduate year [PGY]), medication order timing (time of day and month of year), and rates of medication ordering errors. RESULTS Of 1,772,462 medication orders placed by 335 residents, 68,545 (3.9%) triggered a pharmacist intervention in the electronic medical record. Overall and for each PGY level, renal dose monitoring/adjustment was the most common order error (40%). Ordering errors were less frequent during the night and transition periods versus daytime (adjusted odds ratio [aOR] 0.93, 95% confidence interval [CI] 0.91-0.96, and aOR 0.93, 95% CI 0.90-0.95, respectively). Errors were more common in July and August compared with other months (aOR 1.05, 95% CI 1.01-1.09). Compared with PGY2 residents, both PGY1 (aOR 1.06, 95% CI 1.03-1.10), and PGY3 residents (aOR 1.07, 95% CI, 1.03-1.10) were more likely to make medication ordering errors. Throughout the course of the academic year, the odds of a medication ordering error decreased by 16% (aOR 0.84, 95% CI 0.80-0.89). CONCLUSIONS Despite electronic medical records, medication ordering errors by trainees remain common. Additional supervision and resident education regarding medication orders may be necessary.
Collapse
Affiliation(s)
- Ari Garber
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Amy S Nowacki
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Alexander Chaitoff
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Andrei Brateanu
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Colleen Y Colbert
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Seth R Bauer
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Zubin Arora
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Ali Mehdi
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Simon Lam
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Abby Spencer
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Michael B Rothberg
- From the Departments of Gastroenterology and Hepatology, Quantitative Health Sciences in the Lerner Research Institute, Internal Medicine, and Pharmacy, and the Center for Value Based Care Research, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
31
|
Hada A, Jack L, Coyer F. Using a knowledge translation framework to identify barriers and supports to effective nursing handover: A focus group study. Heliyon 2019; 5:e01960. [PMID: 31294112 PMCID: PMC6595275 DOI: 10.1016/j.heliyon.2019.e01960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/21/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
The aims of this study were to systematically assess the barriers and facilitators to evidence-based nursing handover in a clinical environment, and to identify potential adopters and attributes of evidence-based nursing handover for translation into practice. The study was conducted in the medical wards of a major tertiary referral hospital in Brisbane, Australia. Participants comprised registered and enrolled nurses permanently employed in the participating wards for at least three months prior to the commencement of study. Using a qualitative focus group design, a context specific assessment of the barriers and enablers to knowledge translation was performed through five semi-structured focus groups. Focus groups discussions were recorded by a registered court reporter using a stenotype machine for voice to text transcription, transcribed verbatim and de-identified for analysis. Focus group data were analysed using thematic analysis. Three themes emerged from the focus group discussions: 1) Content (information transferred); 2) Process (steps used to transfer accountability and responsibility for care); and 3) Environment (factors impacting on safe handover). Participants identified barriers to effective nursing handover including variability of handover content and process, uncertainty around sharing sensitive information, inconsistency around clarifying gaps through questioning during the handover, superficial patient involvement, time constraints and environmental challenges. Key facilitators discussed during the focus groups were the use of integrated electronic medical records, support and clear expectations from the nursing leadership and targeted handover education. During the focus group discussions, participants identified several barriers and facilitators to effective handover. These findings will guide the development of research translation strategies to support the implementation of best practice, standardised clinical handover.
Collapse
Affiliation(s)
- Adriana Hada
- Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Leanne Jack
- Post Graduate Study Area Coordinator Intensive Care Nursing and Emergency Nursing, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Fiona Coyer
- Joint Appointment with School of Nursing, Queensland University of Technology and Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
32
|
Pun J, Chan EA, Man M, Eggins S, Slade D. Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong. J Clin Nurs 2019; 28:3001-3011. [PMID: 30938014 DOI: 10.1111/jocn.14871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/15/2019] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. BACKGROUND Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. DESIGN A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. METHODS Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). RESULTS Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. CONCLUSIONS The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. RELEVANCE TO CLINICAL PRACTICE CARE protocol-based training yielded significant improvements in nursing handover practice.
Collapse
Affiliation(s)
- Jack Pun
- Department of English, The City University of Hong Kong, Hong Kong SAR, China
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Manbo Man
- Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Suanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences, Australian National University, Canberra, Australia
| |
Collapse
|
33
|
Devendra GP, Ortiz GM, Haber LA. By the Light of Day: Quality, Safety, and Education During the Overnight Admission Handoff. Cureus 2019; 11:e4529. [PMID: 31263637 PMCID: PMC6592463 DOI: 10.7759/cureus.4529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Current duty hour restrictions have led to increased patient handoffs as well as increased use of faculty in the nocturnist role. Nocturnists typically supervise residents and perform direct patient care leading to a diversity of provider experience level during morning handoffs. In this study, we explored how the presence of nocturnists impacts perceptions patient safety, quality, and educational value of morning care transitions. Methods We performed a cross-sectional survey examining the housestaff and attending perceptions of the morning sign-out of overnight admissions from both night float residents and nocturnists in July of 2016. Survey responses were Likert-style format, querying respondents’ level of agreement (1-5, strongly disagree to strongly agree) with statements. 108 providers responded (41% response rate) Results Relative to attendings, residents reported feeling like they had less time to ask questions (4.0 vs. 5.0, p < 0.001) and felt less comfortable asking questions of the nocturnist during handoff (4.0 vs. 5.0, p < 0.001). Residents were also less comfortable than attendings in changing a nocturnist’s plan of care (4.0 vs. 5.0, p < 0.001). Housestaff reported that receiving signout from the overnight resident was more likely to improve their confidence managing similar conditions (4.0 vs. 3.0, p < 0.001). Conclusion The benefits of nocturnist supervision may come at an educational cost as trainees feel less comfortable asking questions or changing the plan of care. With increasingly prevalent night float systems and nocturnist providers, academic programs have to negotiate the balancing safe and high-quality patient care with creating positive learning environments and clear expectations.
Collapse
Affiliation(s)
- Ganesh P Devendra
- Hospital Medicine, Oregon Health and Sciences University, Portland, USA
| | - Gabriel M Ortiz
- Internal Medicine, University of California San Francisco, San Francisco, USA
| | - Lawrence A Haber
- Internal Medicine - Hospital Based Medicine, University of California San Francisco, San Francisco, USA
| |
Collapse
|
34
|
Hinding B, Deis N, Gornostayeva M, Götz C, Jünger J. Patient handover - the poor relation of medical training? GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc19. [PMID: 30993177 PMCID: PMC6446468 DOI: 10.3205/zma001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Objective: The handover of patients to medical colleagues and to members of other professional groups is a central task in the medical care process for patient safety. Nevertheless, little is known about teaching and testing on the subject of handing over. The present article therefore examines the extent to which handover is the subject of teaching and examinations at medical faculties in Germany. Methodology: In 31 medical faculties the teachers were asked about the implementation of the NKLM learning objectives in the area of communication. The survey was conducted within the framework of group interviews with lecturers, in which it was determined whether each learning objective of the NKLM (National Competency-based Catalogue of Learning Objectives in Medicine) on the subject of communication, is explicitly taught in lectures and examinations at the respective faculty. Results: The learning objective "transfer to medical colleagues" is covered by 19 faculties, while the learning objective of interprofessional transfer is covered by 14 faculties. There are examinations for transfer to medical colleagues and interprofessional transfer at two faculties. There is a highly significant relationship between the total number of communicative learning objectives that are put into practice in a faculty and the coverage of the learning objectives for handover. Conclusions: In the field of communications, the subject of handover is less frequently taught at the faculties and, more importantly, it is less frequently examined than other NKLM contents. This is particularly evident in the interprofessional area. The subject is more likely to be taught as a handover between physicians, while the interprofessional interfaces attract less attention. In terms of patient safety, it would be desirable to give a higher priority to the subject of handover. An inter-faculty exchange and the inclusion of the subject of intra- and interprofessional transfer in state examinations could give the implementation process at the faculties a decisive impetus.
Collapse
Affiliation(s)
- Barbara Hinding
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Nicole Deis
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Maryna Gornostayeva
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Christian Götz
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Jana Jünger
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| |
Collapse
|
35
|
Forbes R. Service dissatisfaction and non-attendance in physiotherapy student-led clinics: a qualitative study. Physiother Theory Pract 2019; 36:1390-1398. [PMID: 30676151 DOI: 10.1080/09593985.2019.1570576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background and Purpose: Student-led physiotherapy clinics are a valuable means for providing education opportunities and cost-effective services to the public. Service dissatisfaction is an important construct in understanding how student-led services can maximize patient care and minimize non-attendance while maintaining effective learning environments. Design: A qualitative interview design was used with semi-structured interviews. Results: Eighteen patients from three different university student-led physiotherapy clinics were interviewed. Five themes emerged that were associated with negative perceptions of service provision: (1) inadequate communication, (2) insufficient supervision, (3) loss of autonomy, (4) time commitment, and (5) continuity of care. Conclusion: The results of this study highlight factors that service providers should consider to mitigate negative patient experiences and relevant implications of dissatisfaction including non-attendance. Ensuring transparency of patient expectations of services and enhancing patient continuity of care between physiotherapists and students are important in minimizing the potentially negative factors associated with student-led health services.
Collapse
Affiliation(s)
- Roma Forbes
- School of Health and Rehabilitation Sciences, University of Queensland , St Lucia, Brisbane, QLD, Australia
| |
Collapse
|
36
|
Muralidharan M, Clapp JT, Pulos BP, Diraviam SP, Baranov DY, Gordon EKB, Lane-Fall MB. How does training in anesthesia residency shape residents' approaches to patient care handoffs? A single-center qualitative interview study. BMC MEDICAL EDUCATION 2018; 18:271. [PMID: 30458779 PMCID: PMC6245869 DOI: 10.1186/s12909-018-1387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Handoffs are a complex procedure whose success relies on mutual discussion rather than simple information transfer. Particularly among trainees, handoffs present major opportunities for medical error. Previous research has explored best practices and pitfalls in general handoff education but has not discussed barriers specific to anesthesiology residents. This study characterizes the experiences of residents in anesthesiology as they learn handoff technique in order to inform strategies for teaching this important component of perioperative care. METHODS In 2016, we conducted a semi-structured interview study of 30 anesthesia residents across all three postgraduate years at a major academic hospital. Interviews were coded by two coders using a grounded theory approach and an iterative process designed to enhance reliability and validity. RESULTS Residents cited lack of consistency as a major impediment to proper handoff education. They found the impact of lectures and written materials to be limited. The level of guidance and direction they received from one-to-one attendings was described as highly variable. Residents' comfort in executing handoffs was heavily dependent on location and situation. They felt that coordination among the parties involved in the handoff was difficult to achieve, causing confusion about the importance of handoffs as well as proper protocol. Finally, residents offered opinions on when handoff education should occur during the residency and had several recommendations for its improving, including standardization of key handoff topics. CONCLUSIONS In a single center study of anesthesiology resident handoff education, residents exhibited confusion related to a perceived disconnect between the stated importance of effective handoffs and a lack of consensus on proper handoff technique. Standardization of curriculum and framing expectations has the potential to enhance resident handoff training in academic anesthesia departments.
Collapse
Affiliation(s)
- Madhavi Muralidharan
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Justin T. Clapp
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Bridget Perrin Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN USA
| | - Sushmitha P. Diraviam
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Dimitry Y. Baranov
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Emily K. B. Gordon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Meghan B. Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
37
|
Lavoie P, Clarke SP, Clausen C, Purden M, Emed J, Mailhot T, Frunchak V. Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses' handoffs using mobile devices. Pilot Feasibility Stud 2018; 4:163. [PMID: 30386630 PMCID: PMC6199701 DOI: 10.1186/s40814-018-0353-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/03/2018] [Indexed: 12/30/2022] Open
Abstract
Background The portability and multiple functionalities of mobile devices make them well suited for collecting field data for naturalistic research, which is often beset with complexities in recruitment and logistics. This paper describes the implementation of a research protocol using mobile devices to study nurses’ exchanges of patient information at change of shift. Methods Nurses from three medical and surgical units of an acute care teaching hospital in Montreal, Canada, were invited to participate. On 10 selected days, participants were asked to record their handoffs using mobile devices and to complete paper questionnaires regarding these exchanges. Nurse acceptance of mobile devices was assessed using a 30-item technology acceptance questionnaire and focus group interviews. The principal feasibility indicator was whether or not 80 complete handoffs could be collected on each unit. Results From October to December 2017, 63 of 108 eligible nurses completed the study. Results suggest that the use of mobile devices was acceptable to nurses, who felt that the devices were easy to use but did not improve their job performance. The principal feasibility criterion was met, with complete data collected for 176, 84, and 170 of the eligible handoffs on each unit (81% of eligible handoffs). The research protocol was acceptable to nurses, who felt the study’s demands did not interfere with their clinical work. Conclusions The research protocol involving mobile devices was feasible and acceptable to nurses. Nurses felt the research protocol, including the use of mobile devices, required minimal investment of time and effort. This suggests that their decision to participate in research involving mobile devices was based on their perception that the study protocol and the use of the device would not be demanding. Further work is needed to determine if studies involving more sophisticated and possibly more demanding technology would be equally feasible and acceptable to nurses. Electronic supplementary material The online version of this article (10.1186/s40814-018-0353-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Patrick Lavoie
- 1William F. Connell School of Nursing, Boston College, Chestnut Hill, MA USA.,Faculty of Nursing, Pavillon Marguerite d'Youville, C.P. 6128 succ. Centre-ville, Montreal, QC H3C 3J7 Canada
| | - Sean P Clarke
- 1William F. Connell School of Nursing, Boston College, Chestnut Hill, MA USA
| | - Christina Clausen
- 3Center for Nursing Research, Jewish General Hospital, Montreal, Canada.,4Ingram School of Nursing, McGill University, Montreal, Canada.,5Department of Nursing, Jewish General Hospital, Montreal, Canada
| | - Margaret Purden
- 3Center for Nursing Research, Jewish General Hospital, Montreal, Canada.,4Ingram School of Nursing, McGill University, Montreal, Canada
| | - Jessica Emed
- 4Ingram School of Nursing, McGill University, Montreal, Canada.,5Department of Nursing, Jewish General Hospital, Montreal, Canada
| | | | - Valerie Frunchak
- 4Ingram School of Nursing, McGill University, Montreal, Canada.,5Department of Nursing, Jewish General Hospital, Montreal, Canada
| |
Collapse
|
38
|
Kim JH, Hur MH, Kim HY. The efficacy of simulation-based and peer-learning handover training for new graduate nurses. NURSE EDUCATION TODAY 2018; 69:14-19. [PMID: 30007141 DOI: 10.1016/j.nedt.2018.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/16/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nursing handovers are a crucial nursing practice for patient safety and continuity of nursing care. As a strategy to improve nursing handovers, it has been suggested that new graduate nurses receive training in how to conduct handovers. OBJECTIVES The purpose of this study was to examine the effects of simulation-based handover training and peer-learning handover training on clinical competence regarding handovers and clinical judgment among new graduate nurses. DESIGN Quasi-experimental research using a nonequivalent control group post-test design. PARTICIPANTS A convenience sample of 55 new graduate nurses with no clinical experience who expected to work at a university hospital were selected. METHODS We measured participants' clinical competence regarding handovers and clinical judgment immediately after completing a training program and after 1 month of working at a hospital to examine the immediate and latent effects of simulation-based and peer-learning handover training, respectively. A researcher-developed clinical competence instrument regarding handovers and a clinical judgment instrument based on the Lasater Clinical Judgment Rubric were used. To identify differences in the effects of simulation-based and peer-learning handover training, we analyzed the data using the independent t-test and paired t-test. When evaluating the latent effects, the participants wrote self-reflection reports. RESULTS There were no significant differences in the immediate effects of the simulation-based training and the peer-learning training. In contrast, in the evaluation of the latent effects, new graduate nurses who received simulation-based training showed significantly higher clinical competence regarding handovers (p = .020) and clinical judgment (p = .033) than their counterparts who received peer-learning training. In the self-reflection reports, 19 participants stated that they had gained more confidence with handovers. CONCLUSION We suggest that simulation-based handover training contributes more to the improvement of new graduate nurses' clinical competence regarding handovers and clinical judgment than peer-learning training.
Collapse
Affiliation(s)
- Jung Hee Kim
- Department of Nursing, Shinsung University, 1 Daehak-ro, Jeongmi-myeon, Dangjin-si, Chungcheongnam-do, 31801, Republic of Korea
| | - Myung-Haeng Hur
- College of Nursing, Eulji University, 77 Gyeryong-ro, 771 beon-gil, Jung-gu, Daejeon 34824, Republic of Korea.
| | - Hyun-Young Kim
- Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Republic of Korea.
| |
Collapse
|
39
|
Fealy G, Donnelly S, Doyle G, Brenner M, Hughes M, Mylotte E, Nicholson E, Zaki M. Clinical handover practices among healthcare practitioners in acute care services: A qualitative study. J Clin Nurs 2018; 28:80-88. [PMID: 30092619 DOI: 10.1111/jocn.14643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine clinical handover practices in acute care services in Ireland. Objectives were to examine clinical handover practices between and within teams and between shifts, to identify resources and supports to enhance handover effectiveness and to identify barriers and facilitators of effective handover. BACKGROUND Clinical handover is a high-risk activity, and ineffective handover practice constitutes a risk to patient safety. Evidence suggests that handover effectiveness is achieved through staff training and standardised handover protocols. DESIGN The study design was qualitative-descriptive using inductive analysis. METHODS The study involved a series of focus group discussions and interviews among a sample of healthcare practitioners recruited from 12 urban and regional acute hospitals in Ireland. A total of 116 healthcare professionals took part in 28 interviews and 13 focus group discussions. We analysed the data using the directed content analysis method. RESULTS Data collection generated rich qualitative data, yielding five categories from which two broad themes emerged: "policy and practice" and "handover effectiveness." The themes and their associated categories indicate that there is limited organisational-level policy and limited explicit training in clinical handover, that medical and nursing handovers are separate activities with somewhat different purposes and different modes of execution, and that several factors in the acute care setting, including location, timing and documentation, act as either barriers or enablers to handover effectiveness. CONCLUSION The evidence in the current study suggests that clinical handover merits increased level of prominence in hospital policies or operating procedures. Medical and nursing handover practices represent distinct activities in their content and execution that may be related to cultural and organisational factors. RELEVANCE TO CLINICAL PRACTICE Achieving multidisciplinary team handover requires a change in embedded traditional practices. Several aspects of the clinical handover activities of nursing and medical staff appear to diverge from best-practice evidence.
Collapse
Affiliation(s)
- Gerard Fealy
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Gerardine Doyle
- UCD College of Business, University College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Hughes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elaine Mylotte
- Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Emma Nicholson
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marina Zaki
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
40
|
Padgett TM. Improving Nurses' Communication During Patient Transfer: A Pilot Study. J Contin Educ Nurs 2018; 49:378-384. [PMID: 30053309 DOI: 10.3928/00220124-20180718-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
A major practice problem is that multiple handoff tools can lead to missed information, adverse patient events, and decreased patient safety. A proper comprehensive patient handoff is a key component to patient safety. The standardization of the handoff process can be a safeguard to lower the risk of adverse patient events. A pilot study was implemented to ascertain whether educating nurses on the expected procedure and documentation of the handoff report when transferring a patient emphasizing the use of SBAR (Situation, Background, Assessment, Recommendation) positively affected the nurses' perceptions of communication during patient transfers. The results brought forth many opportunities for improvement at the practice hospital. J Contin Educ Nurs. 2018;49(8):378-384.
Collapse
|
41
|
Heller RA, Hu L. Making the weekend work: a local quality improvement project to establish and improve the quality of weekend handover. BMJ Open Qual 2018; 7:e000215. [PMID: 30094343 PMCID: PMC6069926 DOI: 10.1136/bmjoq-2017-000215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 06/05/2018] [Accepted: 06/20/2018] [Indexed: 11/04/2022] Open
Abstract
Handover is widely identified by the National Confidential Enquiry into Patient Outcome and Death, the Royal College of Physicians (RCP) and Health Foundation as an area that can lead to shortcomings in patient care. We recognised that the current weekend handover process in the Trauma and Orthopaedics department at Frimley Park Hospital was dated, time-consuming and did not promote handover of sufficient patient details. The Royal College of Surgeons, British Medical Association and RCP have guidelines on handover. Our aim was to use these to establish the quality of handovers and introduce methods to better the accuracy and effectiveness of weekend handover in the department, thus improving patient care and safety. Initially, we measured the quality of the existing handover documentation for how comprehensively it was completed. We then implemented a two-step change, reauditing each step, resulting in a handover tool on the trust intranet. Finally, we repeated our audit to monitor sustainability. The 10 categories measured were: 'Patient name', 'Date of birth', 'Hospital number', 'Date of admission', 'Location', 'Consultant', 'Admission reason', 'Date of operation', 'Frequency of review' and discharge paperwork ('TTO'). The original handover documentation had good compliance with 'Patient name' (99%), 'Hospital number' (94%) and 'Admission reason' (91%) but was poor in all other categories, ranging from 12% to 84%. The only category that met its standard was 'Admission reason'. Almost every category improved with the new intranet tool. Five areas met their standard ('Patient name', 'Location', 'Consultant', 'Admission reason' and 'Frequency of review'). Specific prompts resulted in 100% compliance for 'Frequency of review'. The poorest compliance was again seen for 'TTO' (18%). In a short four months, we created an intranet handover tool that resulted in significant and sustainable improvements in the quality, detail and accuracy of handovers, making identification of sick patients safer and more efficient.
Collapse
Affiliation(s)
| | - Lisi Hu
- Trauma and Orthopaedics, Frimley Health NHS Foundation Trust, Camberley, UK
| |
Collapse
|
42
|
The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department. BMC Emerg Med 2018; 18:16. [PMID: 29940885 PMCID: PMC6019792 DOI: 10.1186/s12873-018-0168-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. Methods This study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department. Results Twenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either ‘useful-very useful’ (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it ‘useful’ to ‘very useful’ in supporting pre-alert. Similarly, 65% (n = 16) stated they ‘often’ or ‘always’ used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured. Conclusion This novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover. Electronic supplementary material The online version of this article (10.1186/s12873-018-0168-3) contains supplementary material, which is available to authorized users.
Collapse
|
43
|
Fitzpatrick D, McKenna M, Duncan EAS, Laird C, Lyon R, Corfield A. Critcomms: a national cross-sectional questionnaire based study to investigate prehospital handover practices between ambulance clinicians and specialist prehospital teams in Scotland. Scand J Trauma Resusc Emerg Med 2018; 26:45. [PMID: 29859121 PMCID: PMC5984735 DOI: 10.1186/s13049-018-0512-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received some attention over recent years there is little evidence to support handover best practice within the prehospital domain. Further research is therefore urgently required to understand the most appropriate way to deliver clinical information exchange in the pre-hospital environment. We aimed to investigate current clinical information exchange practices, perceived challenges and the preferred handover mnemonic for use during transfer of high acuity patients between ambulance clinicians and specialist prehospital teams. METHODS A national, cross-sectional questionnaire study. Participants were road based ambulance clinicians (RBAC) or active members of specialist prehospital teams (SPHT) based in Scotland. RESULTS Over a three month study period there were 247 prehospital incidents involving specialist teams. One hundred ninety individuals completed the questionnaire; 61% [n = 116] RBAC and 39% [n = 74] SPHT. Median length of prehospital experience was 10 years (IQR 5-18). Overall current prehospital handover practices were perceived as being effective (Mdn 4.00; IQR 3-4 [1 = very ineffective - 5 = very effective]) although SPHT clinicians rated handover effectiveness slightly lower than RBAC's (Mdn 3.00 vs 4.00, U = 1842.5, p = .03). 'ATMIST' (Age, Time of onset, Medical complaint/injury, Investigation, Signs and Treatment) was deemed the mnemonic of choice. The clinical variables perceived as essential for handover are not explicitly identified within the SBAR mnemonic. The most frequently reported method of recording and transferring information during handover was via memory (n = 112 and n = 120 respectively) and 'interruptions' were perceived as the most significant barrier to effective handover. CONCLUSION While, overall, current prehospital handover practice is perceived as effective this study has identified a number of areas for improvement. These include the development of a shared mental model through system standardisation, innovations to support information recording and delivery, and the clear identification at incidents of a handover lead. Mnemonics must be carefully selected to ensure they explicitly contain the perceived essential clinical variables required for prehospital handover; the mnemonic ATMIST meets these requirements. New theoretically informed, evidence-based interventions, must be developed and tested within existing systems of care to minimise information loss and risk to patients.
Collapse
Affiliation(s)
- David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA Stirling, Scotland
| | - Michael McKenna
- Scottish Ambulance Service, Glebe Cottage, Strath, Gairloch, Ross-shire IV212BT Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling, FK9 4NF Scion House, Scotland, UK
| | - Colville Laird
- Basics Scotland, Aberuthven Enterpise Park, Sandpiper House, Aberuthven, Auchterarder Scotland
| | - Richard Lyon
- Pre-Hospital Emergency Care, School of Health Sciences, University of Surrey, Guildford, UK
| | - Alasdair Corfield
- Emergency Medical Retrieval Service, School of Medicine, Dentistry and Nursing, University of Glasgow, Wolfson Medical School Building, G12 8QQ Glasgow, Scotland
| |
Collapse
|
44
|
Cohen LJ, Donnenberg VS, Wiernik PH, Newman WC, Amankulor N. Core Entrustable Professional Activities in Clinical Pharmacology for Entering Residency: Value of Interprofessional Health-Care Teams in Medication Prescribing and Medication Error Prevention. J Clin Pharmacol 2018; 58:843-848. [DOI: 10.1002/jcph.1117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence J. Cohen
- University of North Texas System College of Pharmacy; University of North Texas Health Science Center; Fort Worth TX USA
| | - Vera S. Donnenberg
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
| | - Peter H. Wiernik
- Our Lady of Mercy Cancer Center; New York Medical College; Bronx NY USA
| | - William C. Newman
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
| | - Nduka Amankulor
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
| |
Collapse
|
45
|
Merkel MJ, von Dossow V, Zwißler B. [Structured patient handovers in perioperative medicine : Rationale and implementation in clinical practice]. Anaesthesist 2018; 66:396-403. [PMID: 28523364 DOI: 10.1007/s00101-017-0320-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. Therefore, implementing structured handover protocols is pivotal. The perioperative setting is a high-risk environment that is prone to communication failures due to operational design (frequent change of shift due to working time restrictions) and a high work load and multitasking (operating room management, short surgery times, concurrent emergencies). Hence teamwork in the operating room and intensive care unit requires clear and consistent communication. In the perioperative setting, the patient is transferred several times: from the ward to operating room, to recovery, intermediate care/intensive care unit and back to normal ward. This necessitates multiple handovers. Since 2005, the World Health Organization (WHO) requests a structured handover concept that processes all relevant information in a predefined order. The SBAR concept (situation, background, assessment, recommendation) is an intuitive communication concept that can improve quality of patient handovers. This underlines the clinical relevance of a structured handover concept that leads to improved outcomes for every patient.In this review, basic measures for a clear and consistent communication are presented. These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.
Collapse
Affiliation(s)
- M J Merkel
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - V von Dossow
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - B Zwißler
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland
| |
Collapse
|
46
|
Lee SC, Atkinson ME, Minard CG, O'Brien A. Electronic tool helps anaesthesia trainee handovers. CLINICAL TEACHER 2018; 16:58-63. [DOI: 10.1111/tct.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan C Lee
- Anesthesiology DepartmentBaylor College of Medicine Houston Texas USA
| | - Megan E Atkinson
- Anesthesiology DepartmentBaylor College of Medicine Houston Texas USA
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational ResearchBaylor College of Medicine Houston Texas USA
| | - Alice O'Brien
- Anesthesiology DepartmentBaylor College of Medicine Houston Texas USA
| |
Collapse
|
47
|
Ernst KM, McComb SA, Ley C. Nurse-to-nurse shift handoffs on medical-surgical units: A process within the flow of nursing care. J Clin Nurs 2018; 27:e1189-e1201. [PMID: 29314328 DOI: 10.1111/jocn.14254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To qualitatively investigate the medical-surgical nurse shift handoff as a process within the workflow of the exchanging nurses. Specifically, this study sought to identify the ideal handoff, ways the handoff deviated from ideal, and subsequent effect on nursing care. BACKGROUND The functions as well as information content of the handoff have been studied. However, typical studies look at the handoff as an isolated activity utilising nurse perceptions as the primary measure of quality. DESIGN Semi-structured focus groups were conducted to discuss nurses' perspectives on ideal handoffs, ways handoffs deviate from the ideal including frequent and significant deviations and the effects on subsequent care. METHODS Twenty-one medical-surgical nurses participated in one of five audio-taped focus group sessions. Three sessions were conducted at hospital A; two sessions at unaffiliated hospital B. The general inductive approach was used to analyse verbatim transcripts. Transcript segments relevant for answering the research questions were coded as ideal or not ideal. Conceptual themes were then developed. RESULT Two major themes were identified: teams/teamwork and constructing and communicating a shared understanding of the patients' conditions. The importance of nurse preparatory activities was revealed including the incoming nurses reading patients' health records and outgoing nurses rounding on patients. The impact of shared expectations was identified across the team, where teams include, in addition to the two nurses, the electronic health record, other hospital staff and patients/families with a bedside handoff. New potential nurse-centred process and outcome measures were proposed. CONCLUSIONS Evaluating handoffs by their effect on the nursing performance both during and after the handoff offers a new framework to objectively assess handoff effectiveness. RELEVANCE TO CLINICAL PRACTICE The handoff is a process which may significantly affect the incoming nurse's transition into and administration of nursing care.
Collapse
|
48
|
Patient handover in the emergency department: ‘How’ is as important as ‘what’. Int Emerg Nurs 2018; 36:46-50. [DOI: 10.1016/j.ienj.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022]
|
49
|
Salmasi S, Wimmer BC, Khan TM, Patel RP, Ming LC. Quantitative exploration of medication errors among older people: a systematic review. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0468-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
50
|
Handovers in care homes for older people – their type, timing and usefulness. Findings from a scoping review. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17001301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThere is a considerable body of literature on the importance of effective shift handovers in hospitals and other health-care settings but less is known about the transfer of information between staff starting and completing stints of paid work in care homes. In the first of two articles considering this under-explored topic, we report findings from a scoping review examining what is known about shift-to-shift handovers in care homes for older people and their equivalents. It is based on systematic searches of electronic databases of English-language journals on ageing and internet searches for material published between January 2005 and October 2016. Guidance from the regulatory body for health and social care in England, the Care Quality Commission, highlights the importance of handovers in care homes but the degree to which they are embedded into care home routines appears to be variable, influenced by factors such as workplace culture, shift patterns and the extent to which they involve all those on duty or just those with professional qualifications. Staffing shortages and whether or not members of staff are paid for their time attending handovers appear to be further constraints on their use. We conclude that there is considerable scope for further research in this field to identify and develop good practice.
Collapse
|