Abstract
BackgroundEffective clinical handover is fundamental to clinical practice and recognised as a global quality and safety priority. Problems with clinical handover from the emergency department (ED) to inpatient ward across four hospitals in the Illawarra Shoalhaven Local Health District (ISLHD) were identified in a number of reportable clinical incidents. To address this, an ED to inpatient ward electronic clinical handover tool was developed and implemented. However, site uptake of the tool varied from 45 to 90%.AimTo determine the facilitators and barriers of the ED to Ward Handover Tool (EDWHAT) implementation and design strategy to improve local compliance and inform wider implementation.MethodsAn exploratory convergent mixed-method approach was used. Data were collected via a 13-item electronic survey informed by the Theoretical Domains Framework (TDF) distributed to eligible nurses across the health district. Descriptive statistics for quantitative data and thematic analysis for qualitative data were conducted. The data were then integrated and mapped to the TDF and the Behaviour Change Wheel to identify specific behaviour change techniques to support implementation.ResultsThere were 300 respondents. The majority of nurses knew where to locate the tool (91.26%), but 45.79% felt that it was not adequate to ensure safe handover. The most frequently reported factors that hindered nurses from using the tool were inability to access a phone near a computer (44.32%) (environmental domain), being told to transfer the patient before being able to complete the form (39.93%) (reinforcement) and the other nurse receiving (or giving) the handover not using the form (38.83%) (social influence). An implementation checklist to identify barriers and solutions to future uptake was developed.ConclusionTo improve uptake, the functionality, content, and flow of the handover tool must be revised, alongside environmental restructuring. Nurses would benefit from an awareness of each speciality’s needs to develop a shared mental model and monitoring, and enforcement of tool use should become part of a routine audit.
Highlights
Effective clinical handover is fundamental to clinical practice and is recognised as a local [1], national [2], and global [3] quality and safety priority
This was followed by 11 questions focussed on known barriers and enablers to uptake of new tools in the clinical environment generally [2] and specific to the study site [16, 17] that were mapped to the domains of the Theoretical Domains Framework (TDF)
Participant characteristics Of the 300 nurses involved in the study, 80.41% were between 20 and 50 years of age, with just over one third (33.89%) between six and 15 years of experience
Summary
Effective clinical handover is fundamental to clinical practice and recognised as a global quality and safety priority. Ineffective clinical handover increases the risk of patient-related errors as a result of poor communication and the lack of appropriate and timely transfer of critical information at the time of reporting This creates inefficiencies in clinical practice leading to suboptimal patient care [2]. There remain multiple barriers to effective handover including a lack of systematic structure, including incomplete handovers, excessive reliance on memory without reference to written documentation and poor quality of written medical records [6] These barriers are prevalent in the complex and hectic emergency department (ED) context where more than 2.5 million ED to ward clinical handovers occur in Australian hospitals each year [7], and the work pattern is unpredictable making delivery of safe patient handover challenging [8]. Standardised and structured clinical handover results in greater levels of patient satisfaction [11], better understanding of diagnosis and treatment [12], and reduced errors [6, 13]
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