Going the extra mile - cross-border patient handover in a European border region: qualitative study of healthcare professionals' perspectives

Close to the border-Resilience in healthcare in a European border region: Findings of a needs analysis

OBJECTIVES

Promoting resilience, the ability to withstand and overcome challenging situations, is crucial for maintaining the performance of healthcare systems. Unique challenges faced by healthcare facilities in border regions render them particularly vulnerable during crises, emphasizing the need to promote resilience in these areas. The current study evaluated the state and needs of resilience in healthcare professionals in a representative European border region.

METHODS

All hospitals and emergency medical care services in the Euregio Meuse-Rhine (Germany, Belgium, the Netherlands) were approached to participate via an online-survey. Behavioral data on psychological distress (Patient Health Questionnaire-4), work-related stressors, individual resilience (Brief Resilience Scale, Resilience at Work scale), and organizational resilience (Benchmark Resilience Tool-short) were collected.

RESULTS

2233 participants initiated the survey with 500 responses included in the analysis. 46% of the participants indicated clinically significant psychological distress. Most challenging stressors were staff availability, available time, and workload. On average, individual resilience was in the normal range, yet 15.6% showed below average resilience. At the organizational level, healthcare institutions can particularly enhance resilience in the domains of Internal resources, Situation Awareness, and Unity of purpose. Compared to their neighbor countries, German healthcare professionals indicated higher levels of depressive symptoms, were more burdened by work-related stressors, and reported lower levels of organizational resilience.

CONCLUSION

Findings highlight that healthcare institutions not only need to promote the resilience of the individual employee particularly in border regions, healthcare institutions, must also act to be better prepared for potential threats and crises while considering each country's unique needs.

Qualitative expert evaluation of an educational intervention outline aimed at developing a shared understanding of cross-border healthcare

Objectives

Although cross-border healthcare benefits many patients and healthcare professionals, it also poses challenges. To develop a shared understanding of these opportunities and challenges among healthcare professionals, we designed an educational intervention outline and invited experts in healthcare and education to evaluate it. The proposed intervention was based on theoretical principles of authentic, team, and reflective learning.

Methods

Experts (N=11) received a paper outline of the intervention, which was subsequently discussed in individual, semi-structured interviews.

Results

Based on a thematic analysis of the interviews, we identified 4 themes: 1) using the experience you have, 2) learning with the people you work with, 3) taking the time to reflect on the past and future, and 4) adapting the intervention to its context.

Conclusion

According to the experts, the proposed intervention and its three underlying principles can enhance a shared understanding of cross-border healthcare. To unlock its full potential, however, they suggested adjusting the application of learning principles to its specific context. By situating learning in landscapes of practice, the intervention could contribute to the continuous development of cross-border healthcare.

Cross-border simulation training for German and Polish emergency medical teams is feasible: conception and evaluation of a bilingual simulation training

BACKGROUND

Cross-border cooperation of emergency medical services, institutions and hospitals helps to reduce negative impact of national borders and consecutive discrimination of persons living and working in border regions. This study aims to explore the feasibility and effectiveness of a cross-border bilingual simulation training for emergency medical services within an INTERREG-VA-funded project.

METHODS

Five days of simulation training for German and Polish paramedics in mixed groups were planned. Effectiveness of training and main learning objectives were evaluated as pre-post-comparisons and self-assessment by participants.

RESULTS

Due to COVID-19 pandemic, only three of nine training modules with n = 16 participants could be realised. Cross-border-simulation training was ranked more positively and was perceived as more useful after the training compared to pretraining. Primary survey has been performed using ABCDE scheme in 18 of 21 scenarios, whereas schemes to obtain medical history have been applied incompletely. However, participants stated to be able to communicate with patients and relatives in 10 of 21 scenarios.

CONCLUSION

This study demonstrates feasibility of a bilingual cross-border simulation training for German and Polish rescue teams. Further research is highly needed to evaluate communication processes and intra-team interaction during bilingual simulation training and in cross-border emergency medical services rescue operations.

Bilingual resuscitation training does not affect adherence to resuscitation guidelines but reduces leadership skills and overall team performance. An observational study with cross-border German-Polish training

Aim of study

This study aims to investigate feasibility and quality of a bilingual cardiopulmonary resuscitation training with interprofessional emergency teams from Germany and Poland.

Methods

As part of a cross-border European Territorial Cooperation (Interreg-VA) funded project a combined communication and simulation training was organised. Teams of German and Polish emergency medicine personnel jointly practised resuscitation. The course was held in both languages with consecutive translation.Quality of chest compression was assessed using a simulator with feedback application. Learning objectives (quality of cardiopulmonary resuscitation, adherence to guidelines, closed loop communication), and team performance were assessed by an external observer. Coopeŕs Team Emergency Assessment Measure questionnaire was used.

Results

Twenty-one scenarios with 17 participants were analysed. In all scenarios, defibrillation and medication were delivered with correct dosage and at the right time. Mean fraction of correct hand position was 85.7% ± 25.7 [95%-CI 74.0; 97.4], mean fraction of compression depth 75.1% ± 21.0 [95%-CI 65.6; 84.7], compression rate 117.7 min-1 ± 7.1 [95%-CI 114.4; 120.9], and chest compression fraction 83.3% ± 3.8 [95%-CI 81.6; 85.0].Quality of cardiopulmonary resuscitation was rated as "fair" to "good", adherence to guidelines as "good", and closed loop communication as "fair". Bilingual teams demonstrated good situational awareness, but lack of leadership and suboptimal overall team performance.

Conclusion

Bilingual and interprofessional cross-border resuscitation training in German and Polish tandem teams is feasible. It does not affect quality of technical skills such as high-quality chest compression but does affect performance of non-technical skills (e.g. closed loop communication and leadership).

Perceived Quality of Postoperative Handover by Saudi Nurses: A Single-Center Cross-Sectional Study

BACKGROUND

 Handover is considered a basic nursing practice in which a patient's care information is moved to another nurse. Handover of patients after surgery is critical due to a number of care transitions, the presence of a surgical procedure, and the influence of anesthesia. High-quality postoperative handover is essential to safe patient care. Few studies have been conducted to evaluate the quality of current postoperative handover practices and the factors contributing to the quality of such processes, especially in Saudi Arabia.

AIM

 The present research aimed at evaluating nurses' perceptions of postoperative handover quality and assessing factors impacting this process. This cross-sectional study targeted registered nurses with at least one year of professional experience who were actively involved in the conduction of postoperative handovers across various surgical departments. A total sample of 143 nurses was selected via a convenient sampling technique. Study instruments included Handover Quality Rating Form, patient status, and nurses' background characteristics.

RESULTS

 Overall, postoperative handover quality was perceived as high by handing over and receiving nurses. Generally, 55.2% of nurses agreed on the different items supporting the positive circumstance for handover, and 92.3% agreed on the good conduct of handover compared to only 7.69% disagreement (p˂0.001). Significant agreements were observed for teamworking (p˂0.001), as well as four indicators (out of five) measuring the overall handover quality (p<0.001). The type of involved departments impacted significantly the handover quality perception (p=0.004). The respondents' age had a significant effect on quality (p=0.036), as well as circumstances of postoperative handover (p=0.046). Moreover, significant statistical differences were found for the circumstance of handover (p=0.031), as well as teamwork (p=0.019) according to the nurses' roles. Finally, the patient's blood circulation and respiration had a significant effect (p=0.023, p=0.033, respectively), as did the patient's level of consciousness (p=0.006) in the nurses' perception of the overall postoperative handover quality.

CONCLUSION

 Postoperative handover quality was highly perceived by nurses. This research explored a multitude of factors such as patient health status and nurses' socio-demographic variables and their impact on nurses' perception of handover quality. Several nurse and patient-related factors were found to impact the handover process. This current research provided findings that could direct future improvements in nursing handover practice to ensure high-quality patient care.

Design, implementation and evaluation of a postgraduate workshop on cross-border healthcare in Europe – Mixed methods research

Introduction

In European border regions, healthcare providers join forces to make full use of the potential of healthcare. Trainees need to be aware of the challenges and opportunities of cross-border healthcare. To increase such awareness, a workshop was designed, implemented and evaluated. The workshop was entitled ‘Creating cross-border collaborators’ and combined elements of contextual, collaborative and reflective learning. The aim of the study was to understand how this workshop enhanced trainees’ awareness of challenges and opportunities of cross-border healthcare.

Methods

Using a mixed-methods approach, focus-group interviews (QUAL) were held with trainees ( N = 16) and trainees ( N = 13) completed a survey (QUAN) about their workshop experiences. The workshop was held three times for three different groups of trainees.

Results

Quantitative analysis (of surveys) demonstrated increased self-reported awareness of cross-border healthcare. All learning principles contributed to this awareness, however reflective learning slightly less. Qualitative analysis (of focus-group interviews) unearthed the following four themes: (1) Attention to cross-border healthcare fostered awareness of its complexity; (2) real-life examples stimulated recognition of challenges and opportunities; (3) discussions in interdisciplinary and international groups helped to see different perspectives; and (4) reflection made trainees think about their own role and perspective. Quantitative and qualitative data are strongly cohered.

Conclusion

According to participating trainees, a workshop with elements of contextual, collaborative and reflective learning did improve trainee awareness of cross-border healthcare. This study highlights that theoretical insights into learning can and should inform the design and evaluation of workshops.

Out of sight, out of mind? A qualitative study of patients' perspectives on cross-border healthcare in a European border region

OBJECTIVE

To improve our understanding of patients' needs in cross-border healthcare, with a specific focus on handover.

METHODS

In this qualitative study, we conducted narrative interviews with 8 patients who had experienced cross-border healthcare, including handover. Based on an inductive analysis, we crafted stories representing participants' perspectives. Crafted stories attend to the personal character of patients' experiences.

RESULTS

We crafted 3 stories relating patients' cross-border healthcare pathways. We identified 3 recurring issues in these stories: (1) Patient involvement in the decision-making process regarding their healthcare; (2) Communication with their healthcare providers; and (3) Information throughout the healthcare process.

CONCLUSION

The said issues, albeit no novelty in healthcare, seem to be amplified by cross-border barriers, such as system, language, and cultural differences. To empower patients to be involved in their own healthcare process, these issues should become a topic of conversation between patients and healthcare professionals.

PRACTICE IMPLICATIONS

The patient stories in this article could help raise awareness among professionals and patients about the issues patients face in cross-border healthcare. Awareness is a first step in overcoming these issues.

Inter-Regional Hospital Patients' Mobility in Italy

Background: The federalization of the Italian National Health Service (NHS) gave administrative, financial, and managerial independence to regions. They are in reciprocal competition according to the “quasi-market” model. A network of independent providers replaced the state monopoly. The NHS, based on the Beveridge model in which citizens are free to choose their place of treatment, was consolidated. The aim of our research was to analyze the fulfillment of need for hospital services on site and patients’ migration to hospitals of other regions. Material and Methods: We analyzed data from 2013 to 2017 of Hospital Discharge Cards (HDCs) provided by the Ministry of Health. The subjects of the analysis (catchment areas) were the hospital networks of every Italian region. The study of flows was developed through Internal Demand Satisfaction, Attraction, Escape, Attraction, Absorption, and Escape Production indexes. Graphic representations were produced using Gandy’s Nomogram and Qgis software. Results: In the studied period, the mean number of mobility admission was 678.659 ± 3.388, with an increase of 0.90%; in particular, the trend for ordinary regime increased 1.17%. Regions of central/northern Italy have attracted more than 60% of the escapes of the southern ones. Gandy’s Nomogram showed that only nine regions had optimal public hospital planning (Lombardy, Autonomous Province of Bolzano, Veneto, Friuli V.G., Emilia-Romagna, Tuscany, Umbria, Latium and Molise). Conclusion: The central/northern regions appear more able to meet the care needs of their citizens and to attract patients than the southern ones.

Patient handover in a European border region: Cross-sectional survey study among healthcare workers to explore the status quo, potential risks, and solutions

Introduction

While the popularity of international care is rising, the complexity of international care compromises patient safety. To identify risks and propose solutions to improve international care, this study explores experiences of healthcare workers with international handovers in a European border region.

Methods

A cross-sectional survey design was used to reach out to 3000 healthcare workers, working for hospitals or emergency services in three neighboring countries in the Meuse-Rhine Euregion. In total, 846 healthcare workers completed the survey with 35 closed- and open-ended questions about experiences with international patient handover.

Results

One-third of respondents had been involved in international handover in the previous month. The handovers occurred in planned and acute care settings and were supported by numerous, yet varying standardized procedures. Healthcare workers were trained for this in some, but not all settings. Respondents mentioned 408 risks and proposed 373 solutions, which were inductively analyzed. Six identified themes classify the level on which risks and accompanying solutions can be found: awareness, professional competencies, communication between professionals, loss of information, facilities and support, and organizational structure.

Discussion

This study gives insight in international patient handovers in a European border region. Among the biggest risks experienced are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing roles and responsibilities of peers working across the border. Standardization of procedures, harmonization of systems, and the possibility for healthcare workers to get to know each other will contribute to reach common ground and move towards optimized and patient-safer cross-border care.

Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study

Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT).

Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT.

Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist.

Design: Single center two-armed cluster randomized prospective crossover pilot study.

Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen.

Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis.

Intervention: A digital standardized handover checklist (ISBAR₃) was compared to a control checklist (VICUR).

Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes.

Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR₃. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR₃. However, overall compliance was low (25.4% for ISBAR₃ and 15.8% for VICUR).

Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected.

Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.