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Crespo-Mirasol E, Llupià-García A, Bellart-Alfonso J, Peguero-Yus A, Figueras-Retuerta F, Hernández-Aguado AS. Impact of the implementation of a standardised interdisciplinary information transfer method in the delivery room and intermediate obstetric care unit. Enferm Intensiva (Engl Ed) 2024; 35:5-12. [PMID: 37598084 DOI: 10.1016/j.enfie.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/21/2023] [Accepted: 04/10/2023] [Indexed: 08/21/2023]
Abstract
AIM This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. METHOD Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. RESULTS The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p < 0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. CONCLUSIONS There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety.
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Affiliation(s)
- E Crespo-Mirasol
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Departament d'Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Campus Bellvitge, Pavelló de Govern, Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - A Llupià-García
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Instituto de Salud Global de Barcelona (ISGlobal), Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - J Bellart-Alfonso
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Peguero-Yus
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - F Figueras-Retuerta
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A S Hernández-Aguado
- Servicio de Medicina Maternofetal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Choi JY, Byun M, Kim EJ. Educational interventions for improving nursing shift handovers: A systematic review. Nurse Educ Pract 2024; 74:103846. [PMID: 38007849 DOI: 10.1016/j.nepr.2023.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
AIM This study analyzed the components of educational interventions for handovers among nursing students and nurses. BACKGROUND A handover is a communication process that occurs when patient care responsibilities and rights are transferred from one nurse to another. This process is important in nursing to ensure the continuity of nursing care and patient safety. DESIGN A systematic literature review of Korean and international studies was conducted to identify the components of handover educational programs for nursing students and nurses and analyze their effects, thereby providing a basis for the further development of these programs. METHODS Studies published in English or Korean no later than June 30, 2022, were found via an electronic database search using the MEDLINE, Embase, and CINAHL databases. Three reviewers independently evaluated all the studies. These studies focused on educational interventions for nursing students and nurses regarding covering shift-to-shift nursing handovers. After reviewing 1971 extracted articles, 18 satisfied the inclusion criteria. RESULTS Nine articles involved nursing students and nine involved nurses. Four articles covered bedside handovers as educational topics. Educational methods included lectures and active practice. Active practice comprised demonstrations, role-play, and feedback. The main content areas of the educational programs were an introduction to handovers; training regarding how to extract important information for handovers; and strategies using informatic and thematic structures, such as mnemonics, and concept mapping. The patient cases for role-play were provided in forms of written scenarios, virtual electronic charts, videos, scenario-based simulated situations, and actual patient cases assigned in clinical practice. The effects of the educational interventions were evaluated regarding knowledge, performance, and self-efficacy. Performance and self-efficacy were significantly higher in a study in which the intervention group was provided additional individual feedback compared to the control group and in a study in which the intervention group received multiple additional practice opportunities. CONCLUSIONS Handover education for nursing students and nurses should include individual feedback, demonstrations, and opportunities to practice to improve their performance and self-efficacy. Feedback methods should be further developed to increase the effectiveness of educational programs. Sample cases involving patients should be devised to increase these opportunities, and methods for improving educator efficiency should be identified.
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Affiliation(s)
- Jin Yi Choi
- Department of Nursing, Konkuk University, Chungju, Republic of Korea
| | - Mikyoung Byun
- Department of Nursing, Daejeon University, Daejeon, Republic of Korea
| | - Eun Jung Kim
- College of Nursing, Woosuk University, Wanju, Republic of Korea.
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Alcalá Minagorre PJ, Domingo Garau A, Salmerón Fernández MJ, Casado Reina C, Díaz Pernas P, Hernández Borges ÁA, Rodríguez Marrodán B. Safe handoff practices and improvement of communication in different paediatric settings. An Pediatr (Barc) 2023; 99:185-194. [PMID: 37640658 DOI: 10.1016/j.anpede.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/31/2023] Open
Abstract
Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.
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Affiliation(s)
- Pedro J Alcalá Minagorre
- Unidad de Pediatría Interna Hospitalaria, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Araceli Domingo Garau
- Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Cristina Casado Reina
- Unidad de Farmacia de Atención Primaria, Dirección Asistencial Norte de la Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Pilar Díaz Pernas
- Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
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Morán-Pozo C, Luna-Castaño P. Shift change handovers between nurses in Critical Care Units. Enferm Intensiva (Engl Ed) 2023:S2529-9840(23)00012-5. [PMID: 36934076 DOI: 10.1016/j.enfie.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 03/18/2023]
Abstract
AIM To know the characteristics of the handover performed by nurses working in Critical Care Units in Spain. METHODS Descriptive and cross-sectional study, whose population was nurses working in Critical Care Units in Spain. An ad hoc questionnaire was used to explore the characteristics of the process, the training received, the information forgotten and the influence of this activity on patient care. The questionnaire was online and dissemination was done through social networks. The sample was selected by convenience. A descriptive analysis was performed according to the nature of the variables and comparison of groups through ANOVA with R software version 4.0.3 (R Project for Statistical Computing). RESULTS The sample was 420 nurses. Most of them answered that (79,5%) perform this activity in an individual way, from outgoing nurse to incoming nurse. Location varied according to the size of the unit (p<0,05). Interdisciplinary handover was rare (p<0.05). In the last month, with regard to the time of data collection, 29,5% had to contact the unit due to forgetting relevant information, using WhatsApp as the first channel to transmit this information. CONCLUSIONS There is a lack of standardization in the handoff between shifts, in terms of the physical space where it is done, tools to structure the information, participation of other professionals and the use of unofficial communication channels to contact for omitted information during the handover. Shift change was identified as a vital process to ensure continuity of care and patient safety, so further researchs are important for patients handoffs.
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Affiliation(s)
- C Morán-Pozo
- Responsable de Investigación de Enfermería, Hospital Central Cruz Roja, Madrid, Spain.
| | - P Luna-Castaño
- Supervisora de Investigación en Cuidados, Hospital Universitario La Paz, Madrid, Spain
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Le A, Lee MA, Wilson J. Nursing handoff education: An integrative literature review. Nurse Educ Pract 2023; 68:103570. [PMID: 36774702 DOI: 10.1016/j.nepr.2023.103570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023]
Abstract
AIM This integrative review aimed to identify nursing students' experiences of handoff practices and the effects of handoff education in the curriculum on nursing student learning outcomes. BACKGROUND Appropriate handoff communication skills are essential for nursing students to maintain patient safety and prevent adverse events. METHOD A systematic literature search was conducted with keywords related to nursing, student, and handoff in April 2020. Articles should focus on nursing students' handoff education published in English in 2015-2020. Eight articles met the inclusion criteria and were included in this review. RESULTS Nursing students reported discrepancies in handoff experiences; diverse factors influenced their handoff experiences, such as knowledge, anxiety, confidence, and type of student supervision. Various handoff educations were implemented across studies. Some handoff educations significantly improved nursing students' attitudes toward other disciplinary providers, satisfaction, confidence, quality, and clarity in handoff communication; some did not substantially affect their selected outcomes. CONCLUSION This review identified that there are still limited handoff experiences among nursing students and many factors affecting opportunities for their handoff experience. Some handoff education (e.g., structured handoff formats, role-play, simulated scenarios) effectively improved students' communication clarity, confidence levels, and handoff education satisfaction. More handoff education is needed for nursing students to learn safe and quality handoff practices.
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Affiliation(s)
- Anna Le
- TWU Nursing Honors Graduate, Methodist Charlton Medical Center, Dallas, TX 75237, USA.
| | - Mikyoung A Lee
- Doswell Endowed Chair for Informatics and Healthcare Transformation & Professor, Texas Woman's University College of Nursing, Dallas, TX 75235, USA.
| | - Jennifer Wilson
- Clinical Professor & Nursing Honors Program Coordinator, Texas Woman's University College of Nursing, Dallas, TX 75235, USA.
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Saleem AM, Kadi M. Patient handoffs among general surgery residents in Saudi Arabia: a cross-sectional study. BMC Med Educ 2022; 22:626. [PMID: 35982430 PMCID: PMC9389743 DOI: 10.1186/s12909-022-03670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Communication failure is a common cause of adverse events. An essential element of communication among health care providers is patient handoff. Patient handoff is defined as a practice whereby a health care provider transfers a patient's care information to another health care provider to ensure the patient's safety and continuity of care. To explore this practice, we assessed patient handoffs among general surgery residents in Saudi Arabia. METHODS A cross-sectional survey was conducted with individuals in accredited general surgery residency programs in Saudi Arabia between 2020 and 2021. RESULTS Participants comprised 118 general surgery residents: 66 (57.3%) were female; 67 (72.8%) did not receive any formal training on patient handoff; and 35 (38.8%) reported that they were sometimes interrupted during the patient handoff process. The most common reason for such interruptions was medical personnel paging. Furthermore, 60 (68.1%) general surgery residents stated that these interruptions led to a decreased quality of effective communication, 39 (44.3%) believed it led to decreased quality of patient care, 63 (71.5%) believed it led to the loss of some information related to patient handoff, and 16 (18.1%) believed it led to patient harm. Finally, 31 (34.4%) general surgery residents believed that the existing handoff system at their institutions neither adequately protected the patients' safety nor allowed for continuity of care, and 51 (68%) reported that their institution did not have a standardized protocol for the verbal patient handoff process. There was a higher proportion of patients with minor harm among residents who did not, rarely or sometimes received verbal or written hand off instructions compare to those who did so always or most of the time (67% vs. 49%, respectively). CONCLUSION The patient handoff process among general surgery residents in Saudi Arabia is subjective and is not standardized, and if not addressed, may lead to patient harm. Standardizing this process is paramount to improve patient safety.
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Affiliation(s)
- Abdulaziz M Saleem
- Department of General Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mai Kadi
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Nathan CL, Stein L, George LJ, Young B, Fuller J, Gravina B, Dubendorf P, Kasner SE, Kumar MA. Standardized Transfer Process for a Neurointensive Care Unit and Assessment of Patient Bounceback. Neurocrit Care 2021. [PMID: 34791596 DOI: 10.1007/s12028-021-01385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
Background Patients who require readmission to an intensive care unit (ICU) after transfer to a lower level of care (“bounceback”) suffer from increased mortality and longer hospital stays. We aimed to create a multifaceted standardized transfer process for patients moving from the neurointensive care unit (neuro-ICU) to a lower level of care. We hypothesized that this process would lead to improvement in provider-rated safety and a decreased rate of bouncebacks to the neuro-ICU after transfer. Methods The study took place at the Hospital of the University of Pennsylvania from October 2018 to October 2020. A standardized five-step transfer process was created and implemented for transferring patients from the neuro-ICU to a lower level of care. Patient care providers completed a survey before and after implementation of the protocol to assess a variety of components related to safety concerns when transferring patients. The rate of bouncebacks pre and post intervention was calculated by using a two-sample Wilcoxon rank-sum test, and disposition at discharge was calculated by using Fisher’s exact test. Results Of the 1176 total patient transfers out of the neuro-ICU, 29 patients bounced back within 48 h. The average age of patients who bounced back was 63.3 years old, with a similar distribution among men and women. The most common reason for bounceback was respiratory distress, followed by cardiac arrhythmia, stroke, and sepsis. Implementation of the standardized process led to a decrease in provider-rated concern of overall safety (5 to 3, p = 0.008). There was improvement in transfer delays due to bed availability (3 to 4.5, p = 0.020), identification of high-risk patients (5 to 6, p = 0.021), patient assignment to the appropriate level of care (5 to 6, p = 0.019), and use of the electronic medical record handoff indicator (5 to 6, p = 0.003). There was no statistically significant difference in terms of patient bounceback rate after implementation of the process (2.4% vs. 2.5%, p = 1.00) or patient disposition at discharge (p = 0.553). Conclusions Patients who bounceback to the neuro-ICU within 48 h had an increased length of hospital stay, had an increased length of ICU stay, and were more likely to be intubated for more than 96 h. Implementation of a standardized five-step transfer process from the neuro-ICU to a lower level of care resulted in improvement in multiple provider-rated safety outcomes and identification of high-risk patients but led to no difference in the patient bounceback rate or patient disposition at discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01385-z.
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Lane-Fall MB, Christakos A, Russell GC, Hose BZ, Dauer ED, Greilich PE, Hong Mershon B, Potestio CP, Pukenas EW, Kimberly JR, Stephens-Shields AJ, Trotta RL, Beidas RS, Bass EJ. Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial. Implement Sci 2021; 16:63. [PMID: 34130725 PMCID: PMC8204062 DOI: 10.1186/s13012-021-01131-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. METHODS The Handoffs and Transitions in Critical Care-Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). DISCUSSION The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04571749 . Date of registration: October 1, 2020.
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Affiliation(s)
| | - Athena Christakos
- , 3400 Spruce Street 6th Floor Dulles Building, Philadelphia, PA, 19104, USA
| | - Gina C Russell
- , 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA
| | - Bat-Zion Hose
- , 423 Guardian Drive, 333 Blockley Hall, Philadelphia, PA, 19104, USA
| | | | | | | | | | | | - John R Kimberly
- , 3620 Locust Walk, 2109 Steinberg-Dietrich Hall, Philadelphia, PA, 19104, USA
| | | | | | - Rinad S Beidas
- , 3535 Market Street, Ste 3105, Philadelphia, PA, 19104, USA
| | - Ellen J Bass
- Drexel University, 3675 Market Street, Suite 1000, Philadelphia, PA, 19104, USA
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Balslev T, Muijtjens A, de Grave W, Awneh H, van Merriënboer J. How isolation of key information and allowing clarifying questions may improve information quality and diagnostic accuracy at case handover in paediatrics. Adv Health Sci Educ Theory Pract 2021; 26:599-613. [PMID: 33150554 DOI: 10.1007/s10459-020-10001-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/17/2020] [Indexed: 06/11/2023]
Abstract
Handover between colleagues is a complex task. The problem is that handovers are often inadequate because they are not structured according to theoretically grounded guidelines. Based on the cognitive load theory, we suggest that allowing a clarifying dialogue and thereby optimizing germane cognitive load enhances the information quality and diagnostic accuracy at handover, but may prolong handover duration. We also expect that mentioning key information first and thus decreasing intrinsic cognitive load improves information quality and diagnostic accuracy. We developed two representative paediatric cases for presentation in a factorial 2 × 2 design. Sixth-year medical students (N = 80) were randomly assigned to one of four groups that differed with regard to how the case histories were delivered to them (chronological order versus key information mentioned first) and direction of information exchange (unidirectional versus a clarifying dialogue). The receivers of the handover were asked to write a report of the cases and suggest the best diagnosis. Dependent variables were information quality of the written report (Information score), quality of the diagnosis (Diagnostic accuracy score) and the time it took to deliver the written handover case report (Handover report duration). Seen through the lens of cognitive load theory, allowing a clarifying dialogue at handover, and thus optimizing the germane cognitive load, significantly increased the Information score (p < 0.0005), Diagnostic accuracy score (< 0.05) and Handover report duration (p < 0.001).
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Affiliation(s)
- T Balslev
- Department of Paediatrics, Viborg Regional Hospital, Viborg, Denmark.
- Centre for Health Sciences Education (CESU), Aarhus University, Aarhus, Denmark.
| | - A Muijtjens
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - W de Grave
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - H Awneh
- Department of Paediatrics, Viborg Regional Hospital, Viborg, Denmark
| | - J van Merriënboer
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Loefgren Vretare L, Anderzén-Carlsson A. The critical care nurse's perception of handover: A phenomenographic study. Intensive Crit Care Nurs 2020; 58:102807. [PMID: 32044120 DOI: 10.1016/j.iccn.2020.102807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe variations in critical care nurses' perceptions of handover. RESEARCH METHODOLOGY Phenomenographic design using individual interviews for data-collection. SETTING The critical care nurses participating in the study were recruited from critical care units in three hospitals in Sweden. FINDINGS Five descriptive categories were identified: Communication between staff, Opportunity for learning, Patient-centred information gathering as a basis for continuous care, Responsibility for transfers, and Patient safety and quality of care. CONCLUSION Nursing handover is a complex phenomenon, which is understood in various ways. Handover is mediated through communication and marks a shift in responsibility. Handover seems to be related to patient safety and quality of care. There is potential for improvement in the quality of nursing handover in clinical praxis, but further research is needed to determine ways of improving quality of handover.
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Affiliation(s)
- Linn Loefgren Vretare
- Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; Neonatal Intensive Care Unit, Akademiska Sjukhuset, Uppsala, Sweden
| | - Agneta Anderzén-Carlsson
- Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Abstract
BACKGROUND Handoffs at the end of clinical shifts occur with high frequencies in the emergency department setting and they pose an increased risk to patients. There is a need to standardize handoff practices. This study aimed to use an electronic Delphi method to identify the core elements essential for an emergency department physician to physician handoff and propose a framework for implementation. METHODS An electronic Delphi-style study with a national panel of board-certified emergency physicians in Saudi Arabia. The panel was conducted over four rounds. The first to identify elements relevant to the end of shift handoff and categorize them into domains, while the remaining three to score and debate individual elements. RESULTS Twenty-five board-certified emergency physicians from various cities and practice settings were enrolled. All panelists completed the entire Delphi process. Thirty-two elements were identified and classified into 4 domains. The top five rated handoff elements were patient identification, chief complaint history, clinical stability, working diagnosis, and consulting services involved. Panel scores showed convergence as rounds progressed and the final list of elements had a high-reliability score (Cronbach's alpha 0.93). CONCLUSIONS This study yielded an itemized and ranked list of elements that are easy to implement and could be used to standardize patient handoffs by emergency physicians. While this study was conducted on an emergency medicine panel, the methods used may be adapted to develop standardized handoff frameworks that serve different disciplines or practice settings.
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Affiliation(s)
- Khaled Alrajhi
- Department of Emergency Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, King Abdulaziz Medical City, Mail Code: 1428, P.O. Box 22490, Riyadh, 11428, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Abdulmohsen Alsaawi
- King Abdullah International Medical Research Center, King Abdulaziz Medical City, Mail Code: 1428, P.O. Box 22490, Riyadh, 11428, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Quality and Patient Safety, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Goldenberg BA, Carpenter-Kellett T, Gingerich JR, Nugent Z, Sisler JJ. Moving forward after cancer: successful implementation of a colorectal cancer patient-centered transitions program. J Cancer Surviv 2020; 14:4-8. [PMID: 31705370 DOI: 10.1007/s11764-019-00819-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Cancer survivors transitioning between academic comprehensive cancer systems and community general practice settings are vulnerable to discontinuity, inconsistency and variation in care, inappropriate surveillance testing, and a sense of isolation and loss. Though these issues have been well recognized for over a decade and a half in the survivorship, oncologic, and health services literature, there remains a dearth of positive examples of models that have been well received by both the transitioned patient and the providers on either side of the handoff. We herein describe a sustained positive example of a transitions program. This program centers on standardized and personalized survivorship care plans (SCP) to guide follow-up care and recovery. METHODS Following the province-wide introduction of a transitions program for treated stages II and III colorectal cancer (CRC) patients, a post-implementation survey was mailed to transitioned patients with the primary outcome evaluated the patients' perception of improved continuity of care and the main instrument used the Patient Continuity of Care Questionnaire. This was compared against a previously published pre-implementation historical control. RESULTS The data presented comparing pre- and post-implementation patient cohorts reflect significantly improved patient-reported perceptions regarding the enhanced continuity and coordination of their follow-up and survivorship care after the province-wide introduction of a formal transitions process. This SCP intervention has been sustained post implementation. CONCLUSIONS Using, as a starting-point, a standardized electronically SCP, CancerCare Manitoba has successfully facilitated a jurisdiction-wide implementation of a scalable, reproducible, and adaptable transitions program. IMPLICATIONS FOR CANCER SURVIVORS This intervention at the time of transition back to the community has enhanced CRC survivor perception of continuity and coordination of follow-up care.
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O'Reilly-Shah VN, Melanson VG, Sullivan CL, Jabaley CS, Lynde GC. Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study. BMC Anesthesiol 2019; 19:182. [PMID: 31615410 DOI: 10.1186/s12871-019-0858-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs. Methods In this retrospective study, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). We examined the effects of intraoperative handoffs between anesthesia personnel. A total of 12,111 cases performed examined at two hospitals operated by a single healthcare system that were that included in the ACS NSQIP database performed. The presence of attending and anesthetist or resident handoffs, patient age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS) classification, case length, surgical case complexity, and evening/weekend start time were measured. Results A total of 2586 of all cases in the NSQIP dataset experienced a handoff during the case. When analyzed as a single variable, attending handoffs were associated with higher rates of adverse outcomes. However, once confounding variables were added into the analysis, attending handoffs and complete care transitions were no longer statistically significant. Conclusions Inclusion of significant covariates is essential to fully understanding the impact provider handoffs have on patient outcomes. Case timing and lengthy case duration are more likely to result in both a handoff and an adverse event. The impact of handoffs on patient outcomes seen in the literature are likely due, in part, to how covariates were addressed.
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Fehlmann C, Louis Simonet M, Reny JL, Stirnemann J, Blondon K. Associations between early handoffs, length of stay and complications in internal medicine wards: A retrospective study. Eur J Intern Med 2019; 67:77-83. [PMID: 31311699 DOI: 10.1016/j.ejim.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/09/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND In US healthcare system, handoffs are associated with an increase in medical error and in hospital length of stay. In non-US healthcare systems, this phenomenon has not been well studied. We studied the association between early handoffs (EH) in a non-US internal medicine ward with length of stay (LOS), use of resources, major complication (MC) and discharge to post-acute care (PAC) facility. METHODS We conducted a retrospective cohort study on patients admitted to the general internal medicine division. Patients with EH (defined as a transfer of responsibility between primary teams within the first 72 h) were compared with patients without EH. The primary outcome was LOS in the general internal medicine division. Secondary outcomes were the use of resources, the incidence of MC (transfer to intensive care, to intermediate care or death) and discharge to a PAC facility. RESULTS We included 11,869 patients, 38% of whom were in the EH group. Patients were 67.7±16.6 years old and 53% were males. EH was independently associated with an increase of LOS (+6.4% [95% CI, 3.5%-9.5%], P < .001) and with an increased rate of MC (OR 1.3 [95% CI, 1.1-1.7], P = .012). In our subgroup analysis, the association between early handoff and LOS and MC rate were not statistically significant when the admission occurred on public holidays and weekends. CONCLUSIONS Among patients admitted in our general internal medicine division, early handoffs were associated with significantly higher length of stay and major complication rate, but not in patients admitted during week-ends.
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Affiliation(s)
- Christophe Fehlmann
- General Internal Medicine, DMIRG, HUG, Geneva, Switzerland; Emergency Department, DMA, HUG, Geneva, Switzerland.
| | | | - Jean-Luc Reny
- General Internal Medicine, DMIRG, HUG, Geneva, Switzerland
| | | | - Katherine Blondon
- General Internal Medicine, DMIRG, HUG, Geneva, Switzerland; Medical Directorate, HUG, Geneva, Switzerland
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Østergaard KL, Simonsen J, Hertzum M. The Handover from Intensive Care Unit to General Ward: Baseline Performance and Participatory Design of an Electronic Follow-Up Plan. Stud Health Technol Inform 2019; 264:1303-1307. [PMID: 31438136 DOI: 10.3233/shti190437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient health. To mitigate this risk the present study investigates the current use of follow-up plans in the handover from ICU to general ward and proposes a novel design of follow-up plans. On the basis of a record audit we find that follow-up plans exist for only 16% of the audited transfers, that these plans are rarely used, and that 25% of the patients with a plan die within 24 hours of their transfer. In a subsequent series of participatory-design workshops with ICU and ward nurses we devised an electronic follow-up plan that consists of an attend-to list rather than a checklist. The attend-to list specifies the issues of concern but leaves the process of attaining them for the general-ward nurses to decide, thereby acknowledging and utilizing their expertise.
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Affiliation(s)
| | - Jesper Simonsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Morten Hertzum
- Department of Information Studies, University of Copenhagen, Copenhagen, Denmark
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Palese A, Grassetti L, Destrebecq A, Mansutti I, Dimonte V, Altini P, Bevilacqua A, Brugnolli A, Dal Ponte A, De Biasio L, Fascì A, Grosso S, Mantovan F, Marognolli O, Nicotera R, Randon G, Tollini M, Canzan F, Saiani L, Zannini L, Terzoni S, Gonella S. Nursing students' involvement in shift-to-shift handovers: Findings from a national study. Nurse Educ Today 2019; 75:13-21. [PMID: 30669021 DOI: 10.1016/j.nedt.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/16/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. OBJECTIVE To explore nursing students' handover involvement during their clinical rotations and associated factors. METHOD This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. RESULTS Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p < 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p < 0.001) in units with high 'quality of the learning environment' (β = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (β = -0.279, p < 0.001), or by a nurse on a daily basis (β = -0.253, p = 0.004), or by the staff (β = -0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. CONCLUSIONS Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.
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Nelson P, Bell AJ, Nathanson L, Sanchez LD, Fisher J, Anderson PD. Ethnographic analysis on the use of the electronic medical record for clinical handoff. Intern Emerg Med 2017; 12:1265-1272. [PMID: 27832465 DOI: 10.1007/s11739-016-1567-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.
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Affiliation(s)
| | - Anthony J Bell
- RBWH Department of Emergency Medicine, Butterfield St, Herston, QLD, 4006, Australia.
| | - Larry Nathanson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Jonathan Fisher
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Philip D Anderson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
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Stelfox HT, Leigh JP, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, Fowler RA, Soo A, Bagshaw SM. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med 2017; 43:1485-94. [PMID: 28852789 DOI: 10.1007/s00134-017-4910-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/11/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE To provide a 360-degree description of ICU-to-ward transfers. METHODS Prospective cohort study of 451 adults transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24-72 h after transfer. RESULTS Medical records (100%) and survey responses (ICU physicians-80%, ICU nurses-80%, ward physicians-46%, ward nurses-64%, patients-74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6-52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18-1.48), had their questions addressed (OR 3.96, 95% CI 1.33-11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90-7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29-9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). CONCLUSIONS ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement.
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Bergs J, Lambrechts F, Mulleneers I, Lenaerts K, Hauquier C, Proesmans G, Creemers S, Vandijck D. A tailored intervention to improving the quality of intrahospital nursing handover. Int Emerg Nurs 2017; 36:7-15. [PMID: 28807696 DOI: 10.1016/j.ienj.2017.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nursing handover is a process central to the delivery of high-quality and safe care. We aimed to improve the quality of nursing handover from the emergency department to ward and intensive care unit (ICU). METHODS A quasi-experimental non-equivalent control group pre-test - post-test design was applied. Handover quality was measured using the Handover Evaluation Scale (HES). A tailored intervention, inspired by appreciative inquiry, was designed to improve the implementation of an existing handover form and procedure. RESULTS In total 130 nurses participated, 66 before and 64 after the intervention. Initial structure of the HES showed no good fit to our data; the questions were reshaped into 3 dimensions: Quality of information, Interaction and support, and Relevance of information. Following the intervention, mean changes in HES factor scores ranged from -3.99 to +15.9. No significant difference in factor scoring by ward and ICU nurses was found. Emergency department nurses, however, perceived Interaction and support to be improved following the intervention. CONCLUSION The intervention did not result in an improved perception of handover quality by ward and ICU nurses. There was improvement in the perception of Interaction and support among emergency department nurses. The intervention positively effected teamwork and mutual understanding concerning nursing handover practice amongst emergency nurses. In order to improve intrahospital nursing handover, hospital-wide interventions are suggested. These interventions should be aimed at creating a generative story, improving mutual understanding, and establishing a supportive attitude regarding standardised procedures to reduce human error.
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Affiliation(s)
- Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium.
| | | | | | - Kim Lenaerts
- Faculty of Healthcare, PXL University College, Belgium
| | | | - Geert Proesmans
- Emergency Department, General Hospital Vesalius Tongeren, Belgium
| | - Sarah Creemers
- Faculty of Business Economics, Hasselt University, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium; Faculty of Medicine and Life Sciences, Ghent University, Belgium
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Clanton J, Gardner A, Subichin M, McAlvanah P, Hardy W, Shah A, Porter J. Patient Hand-Off iNitiation and Evaluation (PHONE) study: A randomized trial of patient handoff methods. Am J Surg 2016; 213:299-306. [PMID: 27998549 DOI: 10.1016/j.amjsurg.2016.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/15/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND As residency work hour restrictions have tightened, transitions of care have become more frequent. Many institutions dedicate significant time and resources to patient handoffs despite the fact that the ideal method is relatively unknown. We sought to compare the effect of a rigorous formal handoff approach to a minimized but focused handoff process on patient outcomes. METHODS A randomized prospective trial was conducted at a large teaching hospital over ten months. Patients were assigned to services employing either formal or focused handoffs. Residents were trained on handoff techniques and then observed by trained researchers. Outcome data including mortality, negative events, adverse events, and length of stay were collected and compared between formal and focused handoff groups using t-tests and a multivariate regression analysis. RESULTS A total of 5157 unique patient-admissions were stratified into the two study groups. Focused handoffs were significantly shorter and included fewer patients (mean 6.3 patients discussed over 6.7 min vs. 35.2 patients over 20.6 min, both p < 0.001). Adverse events occurred during 16.7% of patient admissions. While overall length of stay was slightly shorter in the formal handoff group (5.50 days vs 5.88 days, p = 0.024) in univariate analysis only, there were no significant differences in patient outcomes between the two handoff methods (all p > 0.05). CONCLUSIONS This large randomized trial comparing two contrasting handoff techniques demonstrated no clinically significant differences in patient outcomes. A minimalistic handoff process may save time and resources without negatively affecting patient outcomes.
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Affiliation(s)
- Jesse Clanton
- Summa Akron City Hospital, Department of Surgery, USA.
| | - Aimee Gardner
- UT Southwestern Medical Center, Department of Surgery, USA
| | | | | | | | - Amar Shah
- Northeast Ohio Medical University, USA
| | - Joel Porter
- Summa Akron City Hospital, Department of Surgery, USA; Northeast Ohio Medical University, USA
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Spooner AJ, Aitken LM, Corley A, Fraser JF, Chaboyer W. Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study. Int J Nurs Stud 2016; 61:165-72. [PMID: 27359100 DOI: 10.1016/j.ijnurstu.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. OBJECTIVE The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. DESIGN A prospective observational study. SETTING A 21-bed medical/surgical adult intensive care unit specialising in cardiothoracic surgery at a tertiary referral hospital in Queensland, Australia. PARTICIPANTS Senior nurses (Grade 5 and 6 Registered nurses) working in team leader roles, employed in the intensive care unit were sampled. METHOD After obtaining consent from nursing staff, team leader handovers were audiotaped over 20 days. Audio recordings were transcribed and analysed using deductive and inductive content analysis. The frequency of content discussed at handover that fell within the a priori categories of the ISBAR schema (Identify-Situation-Background-Assessment-Recommendation) was calculated. RESULTS Forty nursing team leader handovers were recorded resulting in 277 patient handovers and a median of 7 (IQR 2) patients discussed at each handover. The majority of nurses discussed the Identity (99%), Situation (96%) and Background (88%) of the patient, however Assessment (69%) content was varied and patient Recommendations (60%) were discussed less frequently. A diverse range of additional information was discussed that did not fit into the ISBAR schema. CONCLUSIONS Despite universal acknowledgement of the importance of nursing team leader handover, there are no previous studies assessing its content. Study findings indicate that nursing team leader handovers contain diverse and inconsistent content, which could lead to inadequate handovers that compromise patient safety. Further work is required to develop structured handover processes for nursing team leader handovers.
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Affiliation(s)
- A J Spooner
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia; School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan Campus, Brisbane 4111, Australia.
| | - L M Aitken
- School of Nursing and Midwifery, Griffith University, Kessels Rd, Nathan Campus, Brisbane 4111, Australia; NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith University, Menzies Health Institute, Gold Coast 4222, Australia; Intensive Care Unit, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Brisbane 4102, Australia
| | - A Corley
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia
| | - J F Fraser
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane 4032, Australia
| | - W Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Griffith University, Menzies Health Institute, Gold Coast 4222, Australia
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Ballard DH, Samra NS, Griffen FD. Patient handoffs in surgery: Successes, failures and room for improvement. World J Surg Proced 2016; 6:8-12. [DOI: 10.5412/wjsp.v6.i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/27/2016] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
Patient handoffs are transitions where communication failures may lead to errors in patient care. Face-to-face handoffs are preferred, however may not always be feasible. Different models and strategies have been described, yet there are few experimental studies. Expanding the problem, the on-call surgeon may be responsible for many patients, few or none that they admitted. Effective handoffs improve the quality of care and result in fewer errors. Herein we review different models of patient handoffs, comment on common pitfalls, and suggest areas for new research.
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Stelfox HT, Bastos J, Niven DJ, Bagshaw SM, Turin TC, Gao S. Critical care transition programs and the risk of readmission or death after discharge from ICU. Intensive Care Med 2015; 42:401-410. [PMID: 26694189 DOI: 10.1007/s00134-015-4173-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/29/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Critical care transition programs have been widely implemented to improve the safety of patient discharge from ICU, but have undergone limited evaluation. We sought to evaluate implementation of a critical care transition program on patient readmission to ICU (72 h) and mortality (14 days). METHODS Interrupted time series analysis of 32,234 consecutive adult patients discharged alive from medical-surgical ICUs in eight hospitals in two cities between January 1, 2002 and January 1, 2012. A multidisciplinary ICU provider team (physician, nurse, respiratory therapist) that serially evaluated each patient after ICU discharge was implemented in three hospitals in one city (study group), but not the five hospitals in the other city (control group). Temporal changes were examined using multivariable, segmented linear regression models. RESULTS After implementation of the program, there was an immediate non-significant decrease in the absolute proportion of patients readmitted to ICU in the study group (-0.4%, 95% CI -1.7 to +1.0%) and a non-significant increase in the absolute proportion of patients readmitted to ICU in the control group (+1.0%, 95% CI -0.3 to +2.2%). Subsequently, there were non-significant changes in the absolute proportion of patients readmitted to ICU in both the study (+0.1% per quarter; 95% CI, -0.1 to +0.2%) and control (-0.1 per quarter; 95% CI, -0.2 to +0.1%) groups over time. No significant changes were observed in mortality. The results were stable across patient subgroups. CONCLUSIONS Implementation of a critical care transition program was not associated with patient readmission to ICU or mortality.
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Affiliation(s)
- Henry T Stelfox
- Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jaime Bastos
- Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Daniel J Niven
- Departments of Critical Care Medicine, and Community Health Sciences, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - T C Turin
- Department of Family Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Song Gao
- Alberta Health Services, Calgary, Canada
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McElroy LM, Macapagal KR, Collins KM, Abecassis MM, Holl JL, Ladner DP, Gordon EJ. Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study. Am J Surg 2015. [PMID: 26198333 DOI: 10.1016/j.amjsurg.2015.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Operating room (OR) to the intensive care unit (ICU) handoffs are known sources of medical error, yet little is known about the relationship between process failures and patient harm. METHODS Interviews were conducted with clinicians involved in the OR-to-ICU handoff to characterize the relationship between handoff process failures and patient harm. Qualitative analysis was used to inductively identify key themes. RESULTS A total of 38 interviews were conducted. Dominant themes included early communication from the OR to the ICU, team member participation in the handoff, and relationships between clinicians; clinician perspectives varied depending substantially on role within the team. CONCLUSIONS The findings suggest that ambiguous roles and conflicting expectations of team members during the OR-to-ICU handoff can increase risk of patient harm. Future studies should investigate early postoperative ICU care as outcome markers of handoff quality and the effect of interprofessional education on clinician adherence to interventions.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kathryn R Macapagal
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kelly M Collins
- Section of Transplantation, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael M Abecassis
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela P Ladner
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J Gordon
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cheung JY, Mueller D, Blum M, Ravreby H, Williams P, Moyer D, Caroline M, Zack C, Fisher SG, Feldman AM. An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours. Healthc (Amst) 2015; 3:129-34. [PMID: 26384223 DOI: 10.1016/j.hjdsi.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. OBJECTIVE To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). DESIGN Observational pre-post study. METHODS Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). SETTINGS Academic General Medicine inpatient teaching service. RESULTS Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (p<0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (p<0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p<0.01); (iv) overall resident satisfaction with inpatient Medicine teaching service increased from 24.7% to 56.4% (p<0.01); and (v) length-of-stay on inpatient Medicine service decreased from 5.3±6.2 to 4.9±6.8 days (p<0.03). CONCLUSIONS According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.
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Affiliation(s)
- Joseph Y Cheung
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
| | - Daniel Mueller
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Marissa Blum
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Hannah Ravreby
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Paul Williams
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Darilyn Moyer
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Malka Caroline
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Chad Zack
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Susan G Fisher
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
| | - Arthur M Feldman
- Department of Medicine and Department of Clinical Sciences, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140, USA
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Breaux J, McLendon R, Stedman RB, Amedee RG, Piazza J, Wolterman R. Developing a Standardized and Sustainable Resident Sign-Out Process: An AIAMC National Initiative IV Project. Ochsner J 2014; 14:563-568. [PMID: 25598721 PMCID: PMC4295733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Duty hour restrictions imposed upon training physicians have led to increased handoffs and the potential for discontinuity in patient care. Research has demonstrated a significant opportunity for decreasing errors with a standardized handoff process. Thus, we designed a project to implement a standardized approach to handoffs, specifically resident-to-resident handoffs. METHODS We performed an initial assessment of the tools, practices, and policies currently in use to facilitate handoffs institutionally. Subsequently, we created a template within our electronic medical record and paired it with a verbal handoff process. We developed a plan to build department champions to disseminate information and provide mentorship. We intend to evaluate this process at designated intervals to ensure sustainability. RESULTS Survey results were obtained from 45 faculty and 61 residents from a wide representation of specialties. We found that although a subjective sense of satisfaction was present, there was substantial variability between processes. Seventy-two percent of faculty reported at least once identifying a patient safety issue that occurred as a result of the handoff process, but 77% of faculty sometimes or never supervised the process. Eighty percent of residents reported sometimes or never receiving feedback on their handoffs. CONCLUSIONS Based on medicine's evolving environment and an apparent opportunity to optimize resident training and patient safety, we developed a plan to standardize, implement, and evaluate resident handoffs within our system. The results thus far have resulted in a gap analysis that will serve as the basis for reporting finalized data at the conclusion of this prospective study.
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Affiliation(s)
- Jacob Breaux
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Roneisha McLendon
- Department of Anesthesia, Ochsner Clinic Foundation, New Orleans, LA
| | - Robin B. Stedman
- Department of Anesthesia, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Ronald G. Amedee
- Department of Otolaryngology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Janice Piazza
- Department of Graduate Medical Education, Ochsner Clinic Foundation, New Orleans, LA
| | - Robert Wolterman
- Ochsner Medical Center, Ochsner Clinic Foundation, New Orleans, LA
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