Hand-off Communication

Nursing handovers: An integrative review of the different models and processes available

The aim of this study is to explore the different handover models and processes available and their efficacy in improving handover communication within nursing practice. The handover of information is a key nursing responsibility that ensures patient outcomes through continuity of care. This process is widely recognised as an opening for error that may comprise patient safety. This paper is an integrative literature review that employed an inductive exploratory design. A computerised database search was employed including CINAHL, PubMed and Science Direct and a manual citation search with included papers limited to papers published 2005-2016, in English with full text freely available. This included a systematic search strategy, a critical appraisal of the papers utilising the Critical Appraisal Skills Programme, an inductive data extraction and thematic analysis. Sixteen papers were included in this review. The results detailed that there are various handover models in use, yet there is no evidence that any one model displays superior efficacy. The iSoBAR model and its adaptations remain the only model employed across various specialties. More research is warranted to determine if any handover model displays superior efficacy or transferability.

Teaching Active Listening Skills to Pre-Service Speech-Language Pathologists: A First Step in Supporting Collaboration With Parents of Young Children Who Require AAC

Purpose

This study examined the effect of instruction in an active listening strategy on the communication skills of pre-service speech-language pathologists (SLPs).

Method

Twenty-three pre-service SLPs in their 2nd year of graduate study received a brief strategy instruction in active listening skills. Participants were videotaped during a simulated parent meeting before and after the strategy instruction. Simulated parent meetings addressed issues that parents of children who use augmentative and alternative communication (AAC) may face. Social validity measures were gathered from the participants and from parents of children who use AAC.

Results

Pre- and postinstruction use of the active listening strategy was scored and compared using a Wilcoxon signed-ranks test, with statistically significant results. Postinstruction scores were significantly higher than preinstruction scores, providing evidence of the effectiveness of the instruction. Furthermore, participants and parents of children who use AAC described the postinstruction interactions more positively than the preinstruction interactions, suggesting that the pre-service SLPs benefited from the instruction.

Conclusion

The current study provides evidence of the effectiveness of strategy instruction in active listening skills that may be incorporated into SLP preparation programs.

The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units

STUDY OBJECTIVE

To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs).

DESIGN

Prospective, unblinded cross-sectional study.

SETTING

Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually.

PATIENTS

One hundred three surgery patients.

INTERVENTIONS

During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase.

MEASUREMENTS

Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter.

MAIN RESULTS

A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses.

CONCLUSIONS

The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.

A novel glucose-insulin infusion maintains perioperative glycaemic control through multiple transitions of care

To measure the efficacy of the Glucose-Insulin Infusion--Parkland Protocol (GIPPr) compared to subcutaneous (SC) insulin, blood glucose readings were reviewed in diabetic adults admitted for surgical intervention of a soft tissue or bone infection in Dallas, Texas. Hypoglycaemia occurred in 0.69% of readings in GIPPr-treated patients compared to 4.52% in SC-treated patients. The GIPPr maintained a higher proportion of blood glucose readings between 3.89-10 mmol/L compared to SC insulin (85.40% versus 50.68%).

Early identification of children at risk for critical care: standardizing communication for inter-emergency department transfers

BACKGROUND

Interfacility transfers occur frequently and often involve critically ill patients. Clear communication at the time of patient referral is essential for patient safety.

OBJECTIVES

The objective of this work was to study whether a standardized inter-emergency department (ED) transfer communication template for pediatric patients with respiratory complaints identifies patients that require intensive care unit (ICU) admission.

METHODS

We created a template to structure the communication between referring and receiving providers involved in inter-ED transfers of children with respiratory complaints. The template was designed for use by nonphysicians to prompt specific questions that would trigger notification of the ED attending based on signs of critical illness. The template was retrospectively applied to determine whether it would have properly triggered attending physician notification of a child ultimately requiring ICU admission.

RESULTS

Of 285 transferred children, 61 (21%) were admitted to an ICU from the receiving ED. The sensitivity of the communication template in predicting the need for ICU admission was 84% (95% confidence interval [CI], 72%-92%), negative predictive value of 95% (95% CI, 90%-97%), specificity of 77% (95% CI, 71%-82%), positive predictive value of 50% (95% CI, 40%-60%). Of the 10 patients admitted to an ICU who were not identified by the tool, none were critically ill upon arrival. Of the individual communication elements, the sensitivity and negative predictive value ranged from 3% to 38% and from 79% to 86%, respectively.

CONCLUSIONS

A standardized communication template for inter-ED transfers can identify children with respiratory complaints who require ICU admission. Next steps include real-time application to judge screening performance compared with current nonstandardized intake protocols.

Nursing and conflict communication: avoidance as preferred strategy

An exploratory study was conducted to examine nurses' (n = 57) selection of strategies to confront conflict in the workplace. Communication competence is the conceptual framework, defining competent conflict communication as joint problem-solving communication that is both effective and appropriate. Items were drawn from tools assessing nurses' conflict management strategies. Nurses reported a strong preference not to confront conflict directly; nurse managers were less likely to avoid direct communication. Nurses who do choose to confront conflict are more likely to use constructive than destructive strategies. The integration of the social science of health communication into nursing education and practice and other implications are discussed.