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Yung AHW, Pak CS, Watson B. A scoping review of clinical handover mnemonic devices. Int J Qual Health Care 2023; 35:mzad065. [PMID: 37616494 DOI: 10.1093/intqhc/mzad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/26/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Since the Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in 1999, clinical handovers (or handoffs) and their relationship with the communication of patient safety have raised concerns from the public, regulatory bodies, and medical practitioners. Protocols, guidelines, forms, and mnemonic devices have been created to ensure safer clinical handovers. An initial literature search did not find a framework to describe the clinical processes and functions of each mnemonic device and its elements. The absence of a systematic framework could hinder the study across and the reusability of the established clinical handover mnemonic devices. This study aims to develop a universal framework to describe the clinical processes and functions essential for patient safety during handover. We queried PubMed.gov and obtained 98 articles related to clinical handovers. We examined the citing sources of the mnemonics mentioned in these articles. A total of 42 handover mnemonics with 238 elements were identified. Our review noted that there was no taxonomy to describe the clinical functions and process associated with the clinical handover mnemonic devices. We used grounded theory to address this gap and built a new taxonomy from the 42 mnemonics. A researcher read all mnemonics, developed a taxonomy for tagging clinical handover mnemonics, and categorized all mnemonic elements into correct processes and functions. After that, the second researcher, a medical practitioner, examined the taxonomy and made suggested corrections for the labelled functions of all mnemonic elements. Both researchers agreed on the taxonomy and the labelled processes and functions of different mnemonic elements. The taxonomy contains three processes and twenty functions in clinical handovers. Clinical processes like 'medical condition', 'medical history', 'medical evaluation', 'care plan', 'outstanding care/tasks/results', and 'patient information', as an administrative process, were widely adopted in clinical handover mnemonics. Moreover, mnemonic elements on communication manner and information validation had been identified in the list of clinical handover mnemonics. Although we recognize challenges because of both the vast number of clinical handover scenarios and the task of placing them under a few predefined groups, our findings suggest that such a taxonomy, as developed for this study, could assist medical practitioners to devise a clinical handover mnemonic to best fit their workplace.
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Affiliation(s)
- Amos H W Yung
- International Research Centre for the Advancement of Health Communication, Department of English and Communication, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
| | - Chi Shing Pak
- Accident & Emergency Department, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Bernadette Watson
- International Research Centre for the Advancement of Health Communication, Department of English and Communication, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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Devane D, Barrett N, Gallen A, O'Reilly MF, Nadin M, Conway G, Biesty L, Smith V. Identifying and prioritising midwifery care process metrics and indicators: a Delphi survey and stakeholder consensus process. BMC Pregnancy Childbirth 2019; 19:198. [PMID: 31182055 PMCID: PMC6558705 DOI: 10.1186/s12884-019-2346-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background Measuring care processes is an important component of any effort to improve care quality, however knowing the appropriate metrics to measure is a challenge both in Ireland and other countries. Quality of midwifery care depends on the expert knowledge of the midwife and her/his contribution to women and their babies’ safety in the healthcare environment. Therefore midwives need to be able to clearly articulate and measure what it is that they do, the dimensions of their professional practice frequently referred to as midwifery care processes. The objective of this paper is to report on the development and prioritisation of a national suite of Quality Care Metrics (QCM), and their associated indicators, for midwifery care processes in Ireland. Methods The study involved four discrete, yet complimentary, phases; i) a systematic literature review to identify midwifery care process metrics and their associated measurement indicators; ii) a two-round, online Delphi survey of midwives to develop consensus on the set of midwifery care process metrics to be measured; iii) a two-round online Delphi survey of midwives to develop consensus on the indicators that will be used to measure prioritised metrics; and iv) a face-to-face consensus meeting with midwives to review the findings and achieve consensus on the final suite of metrics and indicators. Results Following the consensus meeting, 18 metrics and 93 indicators were prioritised for inclusion in the suite of QCM Midwifery Metrics. These metrics span the pregnancy, birth and postpartum periods. Conclusion The development of this suite of process metrics and indicators for midwifery care provides an opportunity for measuring the safety and quality of midwifery care in Ireland and for adapting internationally. This initial work should be followed by a rigorous evaluation of the impact of the new suite of metrics on midwifery care processes. Electronic supplementary material The online version of this article (10.1186/s12884-019-2346-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Declan Devane
- School of Nursing and Midwifery & HRB-Trials Methodology Research Network National University Ireland Galway, Galway, Ireland
| | - Nora Barrett
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland
| | - Anne Gallen
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, North-West, Galway, Ireland
| | - Mary Frances O'Reilly
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, West/Mid-West, Galway, Ireland
| | - Margaret Nadin
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, Dublin, North East, Ireland
| | - Gillian Conway
- Nursing and Midwifery Planning and Development Unit, Health Services Executive, West/Mid-West, Galway, Ireland
| | - Linda Biesty
- School of Nursing and Midwifery, National University Ireland Galway, Galway, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
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Fabila TS, Hee HI, Sultana R, Assam PN, Kiew A, Chan YH. Improving postoperative handover from anaesthetists to non-anaesthetists in a children's intensive care unit: the receiver's perception. Singapore Med J 2017; 57:242-53. [PMID: 27211792 DOI: 10.11622/smedj.2016090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The efficiency of postoperative handover of paediatric patients to the children's intensive care unit (CICU) varies according to institutions, clinical setup and workflow. Reorganisation of handover flow based on findings from observational studies has been shown to improve the efficiency of information transfer. This study aimed to evaluate a new handover process based on recipients' perceptions, focusing on completeness and comprehensiveness of verbal communication, and the usability of a situation, background, assessment and recommendation (SBAR) form. METHODS This was a prospective interventional study conducted in the CICU of KK Women's and Children's Hospital, Singapore. It comprised four phases: (1) evaluation of the current handover process through an audit and opinion survey; (2) development of a new handover process based on the opinion survey and hospital personnel feedback; (3) implementation; and (4) evaluation of the new handover process. The new handover process was based on a PETS (pre-handover, equipment handover, timeout and sign out) protocol with a 'single traffic communication' flow and a new SBAR handover document. It included relevant patient information, and the options 'not applicable' and 'none', to increase compliance and reduce ambiguity. RESULTS Significantly more recipients indicated that the new SBAR form was the most important handover tool and provided more useful information. Recipients' perceptions indicated improvement in information sufficiency and clarity; reduction of omission errors; and fewer inconsistencies in patient descriptions in the new process. CONCLUSION Dual customisation of the handover process, PETS protocol and SBAR form is necessary to meet the workflow and information demands of the receiving team.
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Affiliation(s)
- Teddy Suratos Fabila
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Hwan Ing Hee
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | - Anne Kiew
- Department of Anaesthesia, Changi General Hospital, Singapore
| | - Yoke Hwee Chan
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
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Kerr D, Klim S, Kelly AM, McCann T. Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre- and post-implementation study. Int J Nurs Pract 2014; 22:89-97. [DOI: 10.1111/ijn.12365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Debra Kerr
- College of Health and Biomedicine; Victoria University; St Albans Victoria Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research; Western Health; St Albans Victoria Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research; Western Health; St Albans Victoria Australia
| | - Terence McCann
- College of Health and Biomedicine; Victoria University; St Albans Victoria Australia
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Spranzi F. Clinical handover on the labour ward: A narrative synthesis of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.10.738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Safety and quality of health care depend on collaborative efforts of multiprofessional and multidisciplinary teams of care providers. Team research in aviation and the military has produced a wealth of knowledge in terms of concepts and intervention strategies to improve team performance. Research on collaborative work in health care in the past 20 years has uncovered unique characteristics and requirements of teams in hospitals and other health care settings and has provided early assessment of the utility of the theoretical concepts, methodologies, and interventions developed outside health care. In this chapter, we review a set of concepts that have been used in characterizing teams in health care and in improving teamwork. These concepts include the organizational shell to capture the sociotechnical environment in which teams reside as well as nontechnical skills, team leadership, team mental models, and so on. We will review a number of leading interventions to enhance team performance, such as teamwork training (e.g., TeamSTEPPS) and structured communication (e.g., SBAR). Future directions are suggested on better understanding of the interdependencies between teams and their organizational shell, such as standardization of operating procedures and training, and to focus on the patient in terms of teamwork improvement.
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Klim S, Kelly AM, Kerr D, Wood S, McCann T. Developing a framework for nursing handover in the emergency department: an individualised and systematic approach. J Clin Nurs 2013; 22:2233-43. [DOI: 10.1111/jocn.12274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research; Western Health; Footscray VIC Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research; Western Health; Footscray VIC Australia
| | - Debra Kerr
- School of Nursing and Midwifery; Victoria University; St Albans VIC Australia
| | - Sallie Wood
- Department of Emergency Medicine; Sunshine Hospital; Western Health; Footscray VIC Australia
| | - Terence McCann
- School of Nursing and Midwifery; Victoria University; St Albans VIC Australia
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Kerr D, McKay K, Klim S, Kelly AM, McCann T. Attitudes of emergency department patients about handover at the bedside. J Clin Nurs 2013; 23:1685-93. [PMID: 23808711 DOI: 10.1111/jocn.12308] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore patients' perspectives of bedside handover by nurses in the emergency department (ED). BACKGROUND International guidelines promote standardisation in clinical handover. Poor handover can lead to adverse incidents and expose patients to harm. Studies have shown that nurses and patients have favourable opinions about handover that is conducted at the bedside in hospital wards; however, there is a lack of evidence for patients' perspective of nursing handover in the ED environment. DESIGN Qualitative descriptive study. METHODS Semi-structured interviews with 30 ED patients occurred within one hour of bedside handover. Data were analysed using thematic content analysis. RESULTS Two main themes were identified in the data. First, patients perceive that participating in bedside handover enhances individual care. It provides the opportunity for patients to clarify discrepancies and to contribute further information during the handover process, and is valued by patients. Patients are reassured about the competence of nurses and continuum of care after hearing handover conversations. Second, maintaining privacy and confidentiality during bedside handover is important for patients. Preference was expressed for handover to be conducted in the ED cubicle area to protect privacy of patient information and for discretion to be used with sensitive or new information. CONCLUSIONS Bedside handover is an acceptable method of performing handover for patients in the ED who value the opportunity to contribute and clarify information, and are reassured that their information is communicated in a private location. RELEVANCE TO CLINICAL PRACTICE From the patients' perspective, nursing handover that is performed at the bedside enhances the quality and continuum of care and maintains privacy and confidentiality of information. Nurses should use discretion when dealing with sensitive or new patient information.
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Affiliation(s)
- Debra Kerr
- School of Nursing and Midwifery, Victoria University, St Albans, Victoria, Australia
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Chin GSM, Warren N, Kornman L, Cameron P. Transferring responsibility and accountability in maternity care: clinicians defining their boundaries of practice in relation to clinical handover. BMJ Open 2012; 2:bmjopen-2011-000734. [PMID: 22952159 PMCID: PMC3437433 DOI: 10.1136/bmjopen-2011-000734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This exploratory study reports on maternity clinicians' perceptions of transfer of their responsibility and accountability for patients in relation to clinical handover with particular focus transfers of care in birth suite. DESIGN A qualitative study of semistructured interviews and focus groups of maternity clinicians was undertaken in 2007. De-indentified data were transcribed and coded using the constant comparative method. Multiple themes emerged but only those related to responsibility and accountability are reported in this paper. SETTING One tertiary Australian maternity hospital. PARTICIPANTS Maternity care midwives, nurses (neonatal, mental health, bed managers) and doctors (obstetric, neontatology, anaesthetics, internal medicine, psychiatry). PRIMARY OUTCOME MEASURES Primary outcome measures were the perceptions of clinicians of maternity clinical handover. RESULTS The majority of participants did not automatically connect maternity handover with the transfer of responsibility and accountability. Once introduced to this concept, they agreed that it was one of the roles of clinical handover. They spoke of complete transfer, shared and ongoing responsibility and accountability. When clinicians had direct involvement or extensive clinical knowledge of the patient, blurring of transition of responsibility and accountability sometimes occurred. A lack of 'ownership' of a patient and their problems were seen to result in confusion about who was to address the clinical issues of the patient. Personal choice of ongoing responsibility and accountability past the handover communication were described. This enabled the off-going person to rectify an inadequate handover or assist in an emergency when duty clinicians were unavailable. CONCLUSIONS There is a clear lack of consensus about the transition of responsibility and accountability-this should be explicit at the handover. It is important that on each shift and new workplace environment clinicians agree upon primary role definitions, responsibilities and accountabilities for patients. To provide system resilience, secondary responsibilities may be allocated as required.
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Affiliation(s)
- Georgiana S M Chin
- Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia
| | - Narelle Warren
- School of Psychology and Psychiatry, Monash University, Caulfield East, Victoria, Australia
| | - Louise Kornman
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Cameron
- Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventative Medicine, The Alfred Centre, Monash University, Melbourne, Victoria, Australia
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Chin GSM, Warren N, Kornman L, Cameron P. Patients' perceptions of safety and quality of maternity clinical handover. BMC Pregnancy Childbirth 2011; 11:58. [PMID: 21827711 PMCID: PMC3167750 DOI: 10.1186/1471-2393-11-58] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care. Methods This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA. Results Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour. Conclusions This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication. Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective. Future research involving patients and their support people in supporting and evaluating handover should be considered.
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Affiliation(s)
- Georgiana S M Chin
- Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Australia.
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