Abstract
BackgroundThe importance and complexity of handovers is well-established. Progress for intervening in the emergency department change of shift handovers may be hampered by lack of a conceptual framework. The objectives were to gain a better understanding of strategies used for change of shift handovers in an emergency care setting and to further expand current understanding and conceptualizations.MethodsObservations, open-ended questions and interviews about handover strategies were collected at a Veteran's Health Administration Medical Center in the United States. All relevant staff in the emergency department was observed; 31 completed open-ended surveys; 10 completed in-depth interviews. The main variables of interest were strategies used for handovers at change of shift and obstacles to smooth handovers.ResultsOf 21 previously identified strategies, 8 were used consistently, 4 were never used, and 9 were used occasionally. Our data support ten additional strategies. Four agent types and 6 phases of the process were identified via grounded theory analysis. Six general themes or clusters emerged covering factors that intersect to define the degree of handover smoothness.ConclusionIncluding phases and agents in conceptualizations of handovers can help target interventions to improve patient safety. The conceptual model also clarifies unique handover considerations for the emergency department setting.
Highlights
The importance and complexity of handovers is well-established
Handovers permeate the health care system, we focused on handovers at change of shift in the emergency departments (ED) at a large urban Veteran Affairs Medical Center (VAMC)
We focus on the VAMC because there are important similarities with other ED settings: compressed timeframe, acute decision-intensive care contexts, heterogeneity of acuity, simultaneous management of varied acuity levels, invasive emergency procedures may need to be performed, and rapid fluctuations in patient volume and acuity levels
Summary
The importance and complexity of handovers is well-established. Progress for intervening in the emergency department change of shift handovers may be hampered by lack of a conceptual framework. BMC Health Services Research 2008, 8:256 http://www.biomedcentral.com/1472-6963/8/256 tion, more protracted hospital stays, and higher return visit rates These potentially serious and overlapping consequences speak to the urgency of better understanding factors relevant to clinical handovers to maximize their effectiveness. Such solutions include trying to structure the information exchanged, creating a standardized framework for the methodology of information exchange [12,13,14,15,16], and/or specific training on handovers and communication [17] This conceptual model may be limiting our vision. Handovers encompass more than communicating patient information and potential communication failures They provide training and socialization opportunities (e.g., reinforcement of cultural practices), offer a fresh set of eyes with the potential of averting or recovering from the sequelae of adverse events, and can impact on team cohesion. Such variability may be more than problems in the communication process. [20]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
