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de Lange S, Heyns T, Filmalter C. A concept analysis of person-centred handover practices: The meaning in emergency departments. Int Emerg Nurs 2024; 74:101446. [PMID: 38677057 DOI: 10.1016/j.ienj.2024.101446] [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] [Received: 07/29/2023] [Revised: 02/22/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Transfer of patients from the prehospital to the in-hospital environment is a frequent occurrence requiring a handover process. Habitually, emergency care practitioners and healthcare professionals focus on patient care activities, not prioritising person-centred handover practices and not initiating person-centred care. AIM The aim of this concept analysis was to define the concept person centred handover practices. METHODS The eight steps for Walker and Avant's method of concept analysis. RESULTS Thirty-one articles were included for final review including qualitative and quantitative studies, literature reviews and audits. This concept analysis guided the development of an concept definition of person-centred handover practices between emergency care practitioners and healthcare professionals in the emergency department as person- centred handover practices are those handovers being performed while including all identified defining attributes such as structure, verbal, and written information transfer, interprofessional process, inclusion of the patient and/ or family, occurs at the bedside, without interruption. CONCLUSIONS Results suggested that person-centred handover practices involve verbal and non- verbal interprofessional communication within a specific location in the emergency department. It requires mutual respect from all professionals involved, experience and training, and the participation of the patient and / or family to improve patient outcomes and quality patient care. A definition for the concept may encourage the implementation of person-centred handover practices in emergency departments.
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Affiliation(s)
- Santel de Lange
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Celia Filmalter
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
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de Lange S, Heyns T, Filmalter C. Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi. J Clin Nurs 2024; 33:1751-1761. [PMID: 38414111 DOI: 10.1111/jocn.16967] [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] [Received: 08/22/2023] [Revised: 10/21/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
Abstract
AIM To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. BACKGROUND Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. DESIGN A three-round online Delphi survey. METHODS Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. RESULTS Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. CONCLUSION Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. REPORTING METHOD The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. IMPACT (ADDRESSING) Improve handover practices and patient care. Improve person-centred care in emergency departments. PATIENT OR PUBLIC CONTRIBUTION Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.
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Affiliation(s)
- Santel de Lange
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Celia Filmalter
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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Chaica V, Marques R, Pontífice-Sousa P. ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review. Healthcare (Basel) 2024; 12:399. [PMID: 38338283 PMCID: PMC10855820 DOI: 10.3390/healthcare12030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The present work aims to map the available scientific evidence on the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context. To this end, a scoping review was conducted, according to the guidelines proposed by the Joanna Briggs Institute (JBI), to answer the following research question: "What are the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context?" The bibliographic search was carried out during August and September 2023 in the following electronic databases: CINAHL Complete; MEDLINE Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and Cochrane Methodology Register. Only works published between 2013 and 2023 were deemed fit for inclusion. All the included studies (9) show that ISBAR methodology, as a standardized tool for transferring nursing care in the emergency service, allows for a safe, clear, and concise transition of nursing care. The benefits relate to patient and professional safety, continuity, and quality of care, as well as patient and professional comfort, with health gains.
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Affiliation(s)
- Veronica Chaica
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Hospital Garcia de Orta, 2805-267 Almada, Portugal
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita Marques
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Portuguese Red Cross Health School, 1300-125 Lisbon, Portugal
| | - Patrícia Pontífice-Sousa
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
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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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Cheetham A, Frey M, Harun N, Kerrey B, Riney L. A Video-Based Study of Emergency Medical Services Handoffs to a Pediatric Emergency Department. J Emerg Med 2023; 65:e101-e110. [PMID: 37365111 DOI: 10.1016/j.jemermed.2023.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Emergency medical services (EMS) to emergency department (ED) handoffs are important moments in patient care, but patient information is communicated inconsistently. OBJECTIVE The aim of this study was to describe the duration, completeness, and communication patterns of patient handoffs from EMS to pediatric ED clinicians. METHODS We conducted a video-based, prospective study in the resuscitation suite of an academic pediatric ED. All patients 25 years and younger transported via ground EMS from the scene were eligible. We completed a structured video review to assess frequency of transmission of handoff elements, handoff duration, and communication patterns. We compared outcomes between medical and trauma activations. RESULTS We included 156 of 164 eligible patient encounters from January to June 2022. Mean (SD) handoff duration was 76 (39) seconds. Chief symptom and mechanism of injury were included in 96% of handoffs. Most EMS clinicians communicated prehospital interventions (73%) and physical examination findings (85%). However, vital signs were reported for fewer than one-third of patients. EMS clinicians were more likely to communicate prehospital interventions and vital signs for medical compared with trauma activations (p < 0.05). Communication challenges between EMS clinicians and the ED were common; ED clinicians interrupted EMS or requested information already communicated by EMS in nearly one-half of handoffs. CONCLUSIONS EMS to pediatric ED handoffs take longer than recommended and frequently lack important patient information. ED clinicians engage in communication patterns that may hinder organized, efficient, and complete handoff. This study highlights the need for standardizing EMS handoff and ED clinician education regarding communication strategies to ensure active listening during EMS handoff.
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Affiliation(s)
- Alexandra Cheetham
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Mary Frey
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nusrat Harun
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kerrey
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Lauren Riney
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio
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Gräff I, Pin M, Ehlers P, Schacher S, Hossfeld B, Strametz R, Matthes G, Gries A, Seidel M. Der Übergabeprozess in der zentralen Notaufnahme – Konsentierung von Inhalten im Rahmen eines Delphi-Verfahrens. Notf Rett Med 2023. [DOI: 10.1007/s10049-023-01130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Zusammenfassung
Hintergrund und Ziel der Arbeit
Für die Übergabe in der Notaufnahme – der Nahtstelle von prähospitaler zu klinischer Versorgung – stellen Merkhilfen („mnemonics“) das „Rückgrat“ für eine strukturierte Übermittlung von relevanten Informationen dar. In Deutschland existiert bis zum heutigen Tag keine Standardisierung bzw. konkrete Vorgabe, welche Merkhilfe zur Übergabe genutzt werden soll. Die vorliegende Untersuchung definiert erstmalig anhand eines strukturierten und mehrstufigen Konsentierungsprozesses (Delphi-Verfahren) von Experten (Mandatsträgern), welche Übergabeinhalte für erforderlich gehalten werden. Ziel dabei ist die Schaffung einer Grundlage zur Entwicklung einer bundeseinheitlichen Merkhilfe.
Methodik
Durchgeführt wurde ein Delphi-Verfahren, welches sich an den Regularien der Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften e. V. (AWMF) orientiert.
Ergebnisse
Im Rahmen des durchgeführten Delphi-Verfahrens konnte neben konkreten Inhalten der Merkhilfe auch deren Reihenfolge festgelegt werden. Übergabeinhalte wurden zu den Punkten Crew Resource Management (CRM) und Patientenidentifikation, Beschreibung der Notfallsituation, Notfallpriorität (ABCDE-Schema) und Vitalparameter, durchgeführte Maßnahmen, Anamnese, Zusammenfassung mit der Möglichkeit für Rückfragen durch das übernehmende Team sowie Zeitdauer definiert.
Diskussion
Die Ergebnisse der Arbeit bilden die evidenzbasierte Grundlage für die Entwicklung einer konkreten Merkhilfe („mnemonic“). Weitere Untersuchungen sollten sich nach Entwicklung einer geeigneten Merkhilfe darauf fokussieren, diese im Rahmen einer (prä-)klinischen Anwendungsstudie auf Praxistauglichkeit zu testen. Gleichzeitig sollte ein entsprechendes Schulungskonzept ausgearbeitet werden. Langfristig wird als Ziel eine bundesweit einheitliche Einführung angestrebt.
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Michael M, Kumle B, Kümpers P, Bernhard M. [Management of Critically Ill Non-traumatic Patients in the Emergency Department]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:466-477. [PMID: 35896385 DOI: 10.1055/a-1545-2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractResuscitation room management of non-traumatic critically ill patients in the emergency department comprises approximately 1.5% of all emergency department visits. Critically ill patients
are usually brought to the hospital by emergency medical services, where they are first examined, given initial treatment, stabilized and then transported for further in-hospital treatment.
Resuscitation room management plays a key role at the interface of the out-of-hospital and in-hospital treatment chains. While the structured care of traumatological patients has been
established at a very high level for decades, the care of non-traumatic critically ill patients within the framework of resuscitation room care has only come into focus in recent years and
is only now being implemented in some places with professional concepts. Emergency departments at all levels of care are equipped to provide structured care for non-traumatologic shock room
patients. To professionalize non-traumatic resuscitation room management, the creation of uniform standards from alerting criteria, to equipment and staffing, as well as the establishment of
a uniform resuscitation room management algorithm is required. The (PRE_E-)AUD2IT-algorithm provides a structure for the non-traumatic care of critically ill patients in the
resuscitation room and includes preparation, resource retrieval, handover, initial care, diagnostics, differential diagnoses and the interpretation of examination findings. This overview
focuses on the management of critically ill non-traumatic patients in respect to the resuscitation room care concept.
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Guasconi M, Bonacaro A, Tamagnini E, Biral S, Brigliadori L, Borioni S, Collura D, Fontana S, Ingallina G, Bassi MC, Lucenti E, Artioli G. Handover methods between local emergency medical services and Accident and Emergency: is there a gold standard? A scoping review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022288. [PMID: 36043950 PMCID: PMC9534252 DOI: 10.23750/abm.v93i4.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pre-hospital emergency medical systems do not appear to work totally coordinated with Accident and Emergency (A&E). Often, patient admission to A&E is marked by scarce attention to the handover between the respective healthcare professionals. This phenomenon is potentially dangerous because it exposes patients to the risk of errors in a context where the patients' critical or progressing conditions must not be worsened by avoidable errors of communication between professionals. OBJECTIVES to describe the evidence concerning handover between local emergency medical services and A&E. ELIGIBILITY CRITERIA pre-hospital emergency medical and A&E professionals, setting defined as within A&E, articles on pre-hospital to A&E handover. SOURCES OF EVIDENCE PubMed and CINAHL Complete databases. Grey literature. CHARTING METHODS the results are displayed in tables according to 'Title', 'Design', 'Country', 'Population', 'Concept', 'Context' and 'Results'. RESULTS 10 studies were included. The following themes emerged: communication and interpersonal issues, secondary risks, need for staff training, the use of structured methods, information technology support. CONCLUSIONS There is a gap in the literature. Issues regarding communication, differing ideas of what should be considered as priority, interpersonal relationships and trust between staff working for different services emerge. Connected with this there are structural problems such as shortage of suitable spaces and lack of staff training. The use of structured mnemonic methods, including computerized ones, seems to improve the quality of handovers, but to date it has not been possible to establish which method would be better than another. Further studies are recommended.
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Affiliation(s)
- Massimo Guasconi
- University of Parma, Department of Medicine and Surgery, Parma, Italy, “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Antonio Bonacaro
- University of Suffolk, School of Health and Sports Sciences, Ipswich, UK
| | - Emanuele Tamagnini
- “Croce Azzurra Riccione” (Local Emergency Medical Service), Riccione (RN), Italy
| | - Silvia Biral
- “Croce Azzurra Riccione” (Local Emergency Medical Service), Riccione (RN), Italy
| | - Linda Brigliadori
- “Azienda Unità Sanitaria Locale” (Local Health Service) Romagna, Rimini, Italy
| | - Sabrina Borioni
- “Azienda Sanitaria Unica Regionale” (Local Health Service) Marche, Fabriano (AN), Italy
| | - Daniele Collura
- “Azienda Socio Sanitaria Territoriale” (Local Health Service) of Crema, Crema (CR), Italy
| | | | - Giulia Ingallina
- “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Maria Chiara Bassi
- “Azienda Unità Sanitaria Locale – IRCCS” (Local Health Service) of Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Lucenti
- “Azienda Unità Sanitaria Locale” (Local Health Service) of Piacenza, Piacenza, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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