Challenges for conducting and teaching handovers as collaborative conversations: an interview study at teaching ICUs.

Addie Johnson,Nico F. Leenstra,Oliver C. Jung,Nicole D. Holman,Lieuwe S. Hofstra,Jaap E. Tulleken

doi:10.1007/s40037-018-0448-3

Addie Johnson, Nico F. Leenstra

Open Access

https://doi.org/10.1007/s40037-018-0448-3

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Abstract

IntroductionWhereas medical shift handovers are increasingly recognized to fulfil important functions beyond information transfer, studies suggest that shift handovers continue to be variably used for reflection, learning or discussion. Little is known of the dynamics of incorporating such functions into ICU shift handovers, resulting in a challenge for the design of educational programs whose underlying philosophies align with the specific requirements of the ICU.MethodsIntensivists, residents and fellows (n = 21) from three ICUs were interviewed to determine perceptions of handover functionality and the boundaries to what must or can be achieved in handover conversations. Interviews were analyzed to isolate training requirements and factors that challenge interactions.ResultsThe analysis revealed that ICU physicians value three functions for shift handovers: information transfer, enhancing shared understanding and decision-making, and learning. The functions towards which physicians are oriented were found to be affected by situational characteristics of cases, individuals, teams, and the unit workflow. Whereas some factors are helpful cues for determining communication needs, others raise dilemmas and misaligned expectations with regards to what can be achieved in the handover.DiscussionOur findings add to the growing case for the education of handovers in complex settings to involve more than information transfers. As residents gain experience, training should be gradually shifted towards more fluid and adaptable approaches to the handover and residents’ ability to engage in joint reflections and discussions. Challenges for engaging in such interactions need to be alleviated, in order to allow the redefinition of handovers as potential sources of safety and learning, rather than error.

Highlights

Whereas medical shift handovers are increasingly recognized to fulfil important functions beyond information transfer, studies suggest that shift handovers continue to be variably used for reflection, learning or discussion
Whereas it is recognized that shift handovers can fulfil important functions beyond information transfer, studies suggest that they continue to be variably used for reflection, discussion or education
Whereas formal requirements for handover training have been introduced into medical education [6], a comprehensive and context-specific system for teaching resident handover skills in the ICU is lacking

Summary

Introduction

Whereas medical shift handovers are increasingly recognized to fulfil important functions beyond information transfer, studies suggest that shift handovers continue to be variably used for reflection, learning or discussion. Whereas formal requirements for handover training have been introduced into medical education [6], a comprehensive and context-specific system for teaching resident handover skills in the ICU is lacking. A growing number of training courses shift the emphasis in teaching from handovers as one-way information transfers towards collaborative dialogues [7,8,9]. This approach emphasizes that communication failures can best be ameliorated through loosely structured, two-way handover interactions, allowing for the ‘co-construction’ of understanding [7, 10,11,12,13,14,15,16]. Training should include teamwork skills that will advance macro-cognitive functions (i. e., the processes by which teams generate new knowledge for addressing unique problems [20]) of handovers, such as re-evaluating situations, reviewing options, and ‘co-orienting’ for future sense- or decision-making [10, 17, 21,22,23,24,25]

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