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Mahran GSK, Mekkawy MM, Ibrahim BA, Saber EA, Ali M, Abbas MS, Mohamed SAA, Ahmed RD. Designing and Validating an Evidence-Based, Shift-to-Shift Handover Bundle for Nurses and Physicians. Crit Care Nurs Q 2024; 47:41-50. [PMID: 38031307 DOI: 10.1097/cnq.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This article reports a study aimed at developing and validating an evidence-based, shift-to-shift handover bundle for nurses and physicians to be used at shift changes in intensive care and emergency units. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability can have unwanted consequences for hospitalized patients, particularly those at critical areas. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, standardized handover bundles for nurses and physicians are limited in the emergency and intensive care unit. As a result of this study, a shift-to-shift handover bundle was created, which was an evidence-based research design. This bundle is expected to be helpful for proper patient transfers between these critical areas, ensuring patient safety and efficient quality management.
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Affiliation(s)
- Ghada Shalaby Khalaf Mahran
- Departments of Critical Care and Emergency Nursing (Drs Mahran and Ali) and Nursing Administration (Dr Saber), Faculty of Nursing, Assiut University, Assiut, Egypt; Department of Medical Surgical Nursing, Al-Galala University, Suez, Egypt (Dr Mekkawy); Department of Medical Surgical Nursing, Minia University, Minia, Egypt (Dr Ibrahim); Departments of Anesthesia and Intensive Care (Dr Abbas) and Chest Diseases and Tuberculosis (Dr Mohamed), Faculty of Medicine, Assiut University, Assiut, Egypt; Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia (Dr Mohamed); and Department of Critical Care and Emergency Nursing, Faculty of Nursing, South Valley University, Qena, Egypt (Dr Ahmed)
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Mamalelala TT, Schmollgruber S, Botes M, Holzemer W. Effectiveness of handover practices between emergency department and intensive care unit nurses. Afr J Emerg Med 2023; 13:72-77. [PMID: 36969481 PMCID: PMC10033719 DOI: 10.1016/j.afjem.2023.03.001] [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: 01/11/2022] [Revised: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
Background Nurses from the emergency department (ED) and the intensive care unit (ICU) must interact during the handover procedure. Factors such as unit boundaries, the interaction between different specialities, patient acuities, and treatment adjustments generate specific negotiating and teamwork problems during the transition of patients from ED to ICU. Objective This study aimed to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the ED and ICU in a major academic hospital in Gauteng province, South Africa. Method An analytical cross-sectional survey design was used. Data were collected using a 16-item handover evaluation tool. It comprises two sections (1) biographical details and (2) 16 statements about handover quality divided into five constructs, namely information transfer, shared understanding, working atmosphere, overall handover quality, and circumstances of handover. Data analysis was done utilising descriptive and non-parametric statistics. Results The majority (51.8%; n = 115) of the handovers occurred during the day. Out of 171 nurses, there were specialist practice emergency (19.2%; n = 33) and intensive care (28.0%; n = 48) nurses. There was statistical significance in information transfer between the ED and ICU nurses. (Me = 4.0, p < 0.05), compared to ICU nurses (Me = 3.0). Nurse specialist and non-specialist nurses' handovers differed statistically significantly on 12 of the 16 items on the rating scale, compared to 10 for non-specialist nurses' handovers. Conclusion The study showed that ED and ICU nurses have significantly different requirements and expectations for handover procedures. In addition to completed documentation, subtle interpretations of the information provided and received also impact the need. The ED and ICU nurses would need to agree on the contents of a structured handover framework because different specialities and departments have varied expectations to achieve an effective handover.
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Affiliation(s)
- Tebogo T. Mamalelala
- School of Nursing, University of Botswana, School of Nursing, Rutgers, The State University of New Jersey, NJ, United States
| | - Shelley Schmollgruber
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Gauteng, South Africa
- Corresponding author:
| | - Meghan Botes
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Gauteng, South Africa
| | - William Holzemer
- School of Nursing, Rutgers, The State University of New Jersey, NJ, United States
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Santos GRDSD, Barros FDM, Silva RCD. Handover communication in intensive therapy: nursing team meanings and practices. ACTA ACUST UNITED AC 2020; 41:e20180436. [PMID: 32294722 DOI: 10.1590/1983-1447.2020.20180436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 08/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the meanings built by the nursing team regarding communication at shift handover in intensive care units. METHOD A qualitative study, grounded on the theoretical framework of Berlo, was developed in the intensive care unit of a hospital in Rio de Janeiro with the nursing team participating in the handover process or working with patient care. Observation and interviews were conducted, with a thorough description of the data and thematic content analysis. RESULTS There is acknowledgment of the meaning of handover in nursing care, which is expressed in behaviors aimed at avoiding inefficacy or the incorrect perception of communication; on the other hand, there is little participation of nursing technicians, with side talks, lack of attention and incomplete information, which compromises their effectiveness. CONCLUSION Professionals should understand their role in the communication process by playing it with active participation to reduce handover noises.
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Affiliation(s)
- Grazielle Rezende da Silva Dos Santos
- Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Departamento de Enfermagem Fundamental. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Fabiana de Mello Barros
- Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Departamento de Enfermagem Fundamental. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Rafael Celestino da Silva
- Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Departamento de Enfermagem Fundamental. Rio de Janeiro, Rio de Janeiro, Brasil
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Colicchio TK, Cimino JJ. Clinicians' reasoning as reflected in electronic clinical note-entry and reading/retrieval: a systematic review and qualitative synthesis. J Am Med Inform Assoc 2020; 26:172-184. [PMID: 30576561 DOI: 10.1093/jamia/ocy155] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective To describe the literature exploring the use of electronic health record (EHR) systems to support creation and use of clinical documentation to guide future research. Materials and Methods We searched databases including MEDLINE, Scopus, and CINAHL from inception to April 20, 2018, for studies applying qualitative or mixed-methods examining EHR use to support creation and use of clinical documentation. A qualitative synthesis of included studies was undertaken. Results Twenty-three studies met the inclusion criteria and were reviewed in detail. We briefly reviewed 9 studies that did not meet the inclusion criteria but provided recommendations for EHR design. We identified 4 key themes: purposes of electronic clinical notes, clinicians' reasoning for note-entry and reading/retrieval, clinicians' strategies for note-entry, and clinicians' strategies for note-retrieval/reading. Five studies investigated note purposes and found that although patient care is the primary note purpose, non-clinical purposes have become more common. Clinicians' reasoning studies (n = 3) explored clinicians' judgement about what to document and represented clinicians' thought process in cognitive pathways. Note-entry studies (n = 6) revealed that what clinicians document is affected by EHR interfaces. Lastly, note-retrieval studies (n = 12) found that "assessment and plan" is the most read note section and what clinicians read is affected by external stimuli, care/information goals, and what they know about the patient. Conclusion Despite the widespread adoption of EHRs, their use to support note-entry and reading/retrieval is still understudied. Further research is needed to investigate approaches to capture and represent clinicians' reasoning and improve note-entry and retrieval/reading.
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Affiliation(s)
- Tiago K Colicchio
- Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Concepts of Organizational Excellence in Medical Associations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2300. [PMID: 31624691 PMCID: PMC6635220 DOI: 10.1097/gox.0000000000002300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
Abstract
Professional associations are integral to the field of medicine; every physician becomes affiliated with at least 1 association throughout his/her entire career. Obtaining membership in such groups advances career development, engages in mentorship, and contributes in legislation and advocacy. Numerous studies have reported the benefits of teamwork in health care, but few have thoroughly investigated the characteristics that lead to organizational success. This article aims to provide a conceptual model for successful high-performing organizations and discuss their fundamental qualities, including structure, trust, productive conflict, accountability, collective success, and leadership. Additionally, we shared evidence-based techniques to establish and maintain these ideals.
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Hovenkamp GT, Olgers TJ, Wortel RR, Noltes ME, Dercksen B, Ter Maaten JC. The satisfaction regarding handovers between ambulance and emergency department nurses: an observational study. Scand J Trauma Resusc Emerg Med 2018; 26:78. [PMID: 30201007 PMCID: PMC6131795 DOI: 10.1186/s13049-018-0545-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A thorough handover in the emergency department (ED) is of great importance for improving the quality and safety in the chain of care. The satisfaction of handover may reflect the quality of handover. Research to discover the variables influencing the satisfaction of handovers is scarce. The goal of this study was to determine the factors influencing the satisfaction regarding handovers from ambulance and ED nurses. METHODS We performed a prospective observational study in the University Medical Center of Groningen. Data regarding prehospital-hospital handovers has been collected by observing handovers and assessing patient chart information. Data regarding the satisfaction has been collected with a questionnaire including a 5-point scale for the level of satisfaction. RESULTS In total, 97 handovers were observed and 97 ambulance nurses and 89 ED nurses completed the questionnaire. The satisfaction of ambulance nurses showed a negative correlation with the waiting time prior to handover (r = -.287, p = .004) and a positive correlation with the presence of a physician in the receiving team (r = .224, p = .028). The satisfaction of ED nurses showed a positive correlation with the use of the ABCDE (r = .288, p = .006) and AMPLE instrument (r = .208, p = .050). CONCLUSION The satisfaction of ambulance and ED nurses as sender or receiver of the handover is determined by different factors. The satisfaction of ambulance nurses is mainly affected by the waiting time and presence of a physician, while the satisfaction of ED nurses is affected by the use of handover instruments and the completeness of medical information.
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Affiliation(s)
- Gijs Thomas Hovenkamp
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Tycho Joan Olgers
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands.
| | - Remco Robert Wortel
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Milou Esmée Noltes
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Bert Dercksen
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
| | - Jan Cornelis Ter Maaten
- Department of Internal Medicine, Emergency Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1 9700RB, Groningen, The Netherlands
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Marshall AP, Tobiano G, Murphy N, Comadira G, Willis N, Gardiner T, Hervey L, Simpson W, Gillespie BM. Handover from operating theatre to the intensive care unit: A quality improvement study. Aust Crit Care 2018; 32:229-236. [PMID: 29706412 DOI: 10.1016/j.aucc.2018.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Transitioning a patient from the operating theatre (OT) to the intensive care unit (ICU) is a dynamic and complex process. Handover of the critically ill postoperative patient can contribute to procedural and communication errors. Standardised protocols are means for structuring and improving handover content. Both have been shown to be effective in reducing information omission and improve communication during this transition period. OBJECTIVES The aim of this uncontrolled before and after study was to improve handover processes and communication about the care for critically ill patients transferred from OT to ICU. METHODS Thirty-two OT to ICU handovers (16 before and 16 after implementation) were observed. Using a structured tool, we documented who was present, participated in, and initiated handover during ICU admission. Where and when handover was performed, information provided, distractions and interruptions, and handover duration were also recorded. Unstructured field notes and diagrams provided information on staff interaction. Following implementation, semistructured interviews with 27 participants were conducted to understand participants' perceptions of intervention acceptability and to determine factors influencing intervention implementation and spread. FINDINGS Following implementation, a "hands-off" approach was observed with fewer technical tasks completed during handover (43.8% before implementation vs 12.5% after implementation) without an increase in handover time. A single, multidisciplinary handover most often led by the anaesthetist was observed after implementation. Despite these improvements, the use of the physical checklist was not observed in practice, and an situation, background, assessment, recommendation (SBAR) format was not followed. Anaesthetists leading the handover did not view the handover checklist as being beneficial to their practice although some nurses were observed to use the checklist as a prompt for additional information. CONCLUSIONS A single, multidisciplinary handover demonstrated improvement in handover practice despite low uptake of the protocol checklist. Further information is required to inform targeted strategies to improve uptake and sustainability although broader interdisciplinary engagement and commitment may be helpful.
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Affiliation(s)
- Andrea P Marshall
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia; Griffith University, Parklands Drive, Southport, QLD 4222, Australia.
| | - Georgia Tobiano
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia; Griffith University, Parklands Drive, Southport, QLD 4222, Australia.
| | - Niki Murphy
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Greg Comadira
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Nicola Willis
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Therese Gardiner
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Lucy Hervey
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Wendy Simpson
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Brigid M Gillespie
- Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia; Griffith University, Parklands Drive, Southport, QLD 4222, Australia.
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Santos GRDSD, Campos JF, Silva RCD. Handoff communication in intensive care: links with patient safety. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To gather scientific evidence about ICU handoff practices and their implications on the safety of communication among team members about hospitalized patients. Method: This was an integrative review conducted in the Medline, PubMed, Cinahl and Scopus databases with the descriptors patient handoff, communication, patient safety, critical care, health communication and intensive care unit. The adopted criteria were: full text, in Portuguese or English, in the last 10 years, with level of evidence over IV and compliance to the study question. Fifteen articles were submitted to a structured tool and analysis. Results: There is evidence of incompleteness, absence or errors in handoff information, caused by the lack of standardization and preparation for this activity, generating delayed, incorrect or non-performed procedures. The use of tools reduces the amount of omitted information, side talks, and errors, improving team satisfaction. Final considerations: It is necessary to promote safe communication in handoff, implementing practices that ensure care continuity.
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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.
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Roslan SB, Lim ML. Nurses’ perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816678423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care. Aim: To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore. Methodology: An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis. Results: Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients. Conclusion: This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.
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Affiliation(s)
| | - Mei Ling Lim
- Division of Nursing, Singapore General Hospital, Singapore
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Yang JG, Zhang J. Improving the postoperative handover process in the intensive care unit of a tertiary teaching hospital. J Clin Nurs 2016; 25:1062-72. [PMID: 26814685 DOI: 10.1111/jocn.13115] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to improve the postoperative handover process and immediate postoperative patient outcomes. The objective was to implement a postoperative handover protocol in the neurosurgical intensive care unit of a tertiary teaching hospital. BACKGROUND Postoperative handover is a multidisciplinary collaborative medical activity that involves information transfer, sequenced tasks and high-quality teamwork. Evidence suggests that a lack of a standardised postoperative handover protocol adversely influences care quality and potentially compromises patient safety. As there is a lack of such protocols in China, there is an identified need for improvement. DESIGN This was a pretest/post-test study with follow-up after three months. METHODS A postoperative handover protocol that included a postoperative handover checklist, a standardised handover pathway and core team member involvement was developed based on research evidence and expert opinions and was then implemented and evaluated. RESULTS Following the implementation of this protocol, improved teamwork was achieved, surgeons were more frequently present at bedside handovers, the rate of transferring key messages increased, the rate of ventilator weaning within the first six hours of neurosurgical intensive care unit admission increased, and the ventilation duration per patient decreased without any clinical incident occurring in the first 24 hours after neurosurgical intensive care unit admission. CONCLUSIONS Following the implementation of a tailored standardised handover protocol, communication, teamwork and short-term patient outcomes were improved. RELEVANCE TO CLINICAL PRACTICE This clinically based research highlights the need for policy makers and administrators to create unit-specific protocols for improving postoperative handovers.
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Affiliation(s)
- Jian-Guo Yang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,HOPE School of Nursing, Wuhan University, Wuhan, China
| | - Jun Zhang
- HOPE School of Nursing, Wuhan University, Wuhan, China
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