Clinical Handover Research Articles

Indoor CO2 monitoring in a surgical intensive care unit under visitation restrictions during the COVID-19 pandemic.

Indoor CO2 concentration is an important metric of indoor air quality (IAQ). The dynamic temporal pattern of CO2 levels in intensive care units (ICUs), where healthcare providers experience high cognitive load and occupant numbers are frequently changing, has not been comprehensively characterized. We attempted to describe the dynamic change in CO2 levels in the ICU using an Internet of Things-based (IoT-based) monitoring system. Specifically, given that the COVID-19 pandemic makes hospital visitation restrictions necessary worldwide, this study aimed to appraise the impact of visitation restrictions on CO2 levels in the ICU. Since February 2020, an IoT-based intelligent indoor environment monitoring system has been implemented in a 24-bed university hospital ICU, which is symmetrically divided into areas A and B. One sensor was placed at the workstation of each area for continuous monitoring. The data of CO2 and other pollutants (e.g., PM2.5) measured under standard and restricted visitation policies during the COVID-19 pandemic were retrieved for analysis. Additionally, the CO2 levels were compared between workdays and non-working days and between areas A and B. The median CO2 level (interquartile range [IQR]) was 616 (524-682) ppm, and only 979 (0.34%) data points obtained in area A during standard visitation were ≥ 1,000 ppm. The CO2 concentrations were significantly lower during restricted visitation (median [IQR]: 576 [556-596] ppm) than during standard visitation (628 [602-663] ppm; p < 0.001). The PM2.5 concentrations were significantly lower during restricted visitation (median [IQR]: 1 [0-1] μg/m3) than during standard visitation (2 [1-3] μg/m3; p < 0.001). The daily CO2 and PM2.5 levels were relatively low at night and elevated as the occupant number increased during clinical handover and visitation. The CO2 concentrations were significantly higher in area A (median [IQR]: 681 [653-712] ppm) than in area B (524 [504-547] ppm; p < 0.001). The CO2 concentrations were significantly lower on non-working days (median [IQR]: 606 [587-671] ppm) than on workdays (583 [573-600] ppm; p < 0.001). Our study suggests that visitation restrictions during the COVID-19 pandemic may affect CO2 levels in the ICU. Implantation of the IoT-based IAQ sensing network system may facilitate the monitoring of indoor CO2 levels.

AB127. SOH23ABS_091. Pilot study to develop a pre-operative “cardiothoracic clinical handover tool” and its effect on handover quality

Background: Clinical handover is an essential step in the surgical patient’s hospital journey but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team.

O.40.5 - Assessing Medical Student English Language Proficiency in Clinical Handover at Semmelweis University: Presenter(s): Magdolna Horváthné Pálinkás, Semmelweis University, Hungary

O.40.5 - Assessing Medical Student English Language Proficiency in Clinical Handover at Semmelweis University: Presenter(s): Magdolna Horváthné Pálinkás, Semmelweis University, Hungary

Using a simulation-based approach to promote structured and interactive nursing clinical handover: a pre- and post-evaluation pilot study in bilingual Hong Kong

Effective clinical nursing handover involves the transfer of responsibility and accountability for patient care between nurses, leading to better patient safety and continuity of care. Nurses in bilingual contexts, such as Hong Kong – where nurses are trained in English but communicate in Cantonese – may find it challenging to deliver a safe clinical handover. This article reports a pilot study in which a simulation-based approach is being developed to enhance nursing handover with structured and interactive interactions, using handover protocols such as ISBAR (introduction, situation, background, assessment, recommendation and readback) and CARE-team (connect, ask, respond, empathise) protocols in a bilingual context. The study has a pre‐ and post-evaluation design involving a questionnaire survey before and after a 4‐hour workshop. Fourteen selected bilingual nurses in Hong Kong were trained according to the ISBAR and CARE-team protocols, and their perceptions of complete and structured handovers were evaluated before and after training using the questionnaire. The nurses reported that they were more self-confident in their handover experiences, with a deeper understanding of ISBAR and CARE-team protocols after the simulation-based training intervention, leading to better (i.e., more structured and interactive) clinical handover between nurses. Overall, the staff perceived their handover communication to have improved using simulation-based training.

Improving patient handover: A narrative review.

The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.

Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial

IntroductionPoor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality...

Implementation of Prehospital Handover in the Emergency Department: A Proposed Novel SRCA Checklist in Saudi Arabia

Background: Maintaining effective clinical handover between prehospital services and emergency departments is crucial to recognize critical cases, guiding proper management, and determining final outcomes. Methods: This is a single-center cross-sectional study that was conducted between October 15, 2021, and July 30, 2022, in a tertiary care center in Riyadh, Saudi Arabia. A novel handover tool (SRCA checklist) was developed, and eight emergency medicine consultants checked its content validity. It contains 4 domains and 12 items and is based on previously validated tools after an extensive literature review and experts&amp;apos; opinions. The primary outcome of this study was to validate the newly developed tool aimed at assessing the quality of handover skills between prehospital medical care providers and emergency departments. The tool\&amp;apos;s reliability was examined using Cronbach\&amp;apos;s alpha method, while factor analysis with varimax rotation was used to examine the construct validity. Results: 147 handovers were captured in this study. Almost 50% of the observed handovers adhered to 7 out of 12 checklist criteria for assessing the handover quality. The chief complaint and associated symptoms were reported in 94.56% (n=139) of cases, and verbalizing of the Airway–Breathing–Circulation–Disability–Exposure (ABCDE) was seen in 75% (n=111) of cases.

General practitioners' perspectives on discharge summaries from a health network of three hospitals in South Australia.

ObjectivesTo explore general practitioners' perspectives on the discharge summaries they receive about their patients who have been discharged from hospital.MethodsA survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content.ResultsA total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated.ConclusionsGeneral practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care.

An evaluation of standardised pharmaceutical handover on critical care units

Abstract Introduction Patients cared for in the Critical Care unit are severely ill and may require multiple changes to their usual medication and new medicines to manage their current clinical condition. Due to pharmacist working patterns at University Hospital Southampton (UHS) patients on the Critical Care unit will receive pharmaceutical care from more than one pharmacist. It is vital that any changes are communicated between members of the pharmacy team as deliberate clinical decisions and not accidental omissions or errors. It is recognised that transfer of patients between professionals or teams caring for them is “one of the very high-risk transactions of health care service” 1. Errors of omission in medication for chronic conditions on Critical Care may lead to continuing omission of this therapy following discharge from hospital.2 Aim To assess the impact on pharmacist time and patient care of a formalised pharmaceutical handover for Critical Care patients at UHS. Methods Handovers are part of routine pharmaceutical care and ethics approval was not required. A pharmacist handover tool was developed within the existing Microsoft Access database used on Critical Care at UHS. Prior to the implementation a cohort of patients were identified and followed up on Critical Care discharge. Data were collected regarding pharmacist documented pre-Critical care medication, changes to this medication, ITU prophylaxis therapies. Following implementation, a second cohort was identified and a further data set collected. Data was analysed using a series of chi-squared tests and two-sample t-tests. Qualitative data were collected about ward pharmacist perceptions of pharmaceutical handover issues from Critical Care and regarding the Critical Care pharmacists’ use of the system and perceptions following its introduction. Ethical approval was not required for this service development initiative and evaluation. Results Favourable trends were detected following the introduction of the standardised handover tool: these did not reach statistical significance in most of the outcomes measured. There wasa statistical difference in the number of changes to pre-ITU medication detected following the handover introduction (p=0.028). The ward pharmacists consulted often had queries about medication changes. Within the critical care team the system was regarded as easy to use and useful. Discussion/Conclusion The standardised handover was well received by the Critical Care team who considered it to be simple to use and a useful tool. Statistical significance was not reached for the majority of measures although a positive trend was detected, probably due to the small sample size. Further standardisation handover system will ensure consistency of pharmaceutical care for this group of complex patients. Since this project was completed, the tool developed has been incorporated into the clinical information system now used within the Trust and has been developed further as an integrated part of the system. The tool is also used within other areas who use the clinical information system and will be reviewed and developed for their specialist areas including neonatal and paediatric intensive care where the information hand over may require different priority areas to be highlighted. Ward pharmacists are also able to access the clinical information handover tool and has led to a reduction in post-critical care queries.

'REDI TO CHAT?' Evaluating the effect of two structured tools on the confidence of nursing and care staff working in residential aged care facilities in Australia: A pre-post survey design.

The objective of the study was to evaluate the effect of two self-designed structured clinical tools on overall self-perceptions of confidence in the assessment, management and communication of acutely unwell residents in nursing and care staff of residential aged care facilities (RACFs). Quasi-experimental pre-post design using surveys in 22 RACFs in Metropolitan Sydney, Australia. A convenience sample of 254 nursing and care staff were recruited. Two structured tools were developed to enhance confidence: (1) RACF Emergency Decision Index (REDI) and (2) Clinical Handover Assessment Tool (CHAT). The REDI is a clinical decision guide for treatment implementation and escalation, and the CHAT is a structured communication aid. Surveys were administered to participating nursing and care staff working within the RACFs prior to the implementation of the two structured tools (T0) and 6 months later (T1). There was a significant increase in reported overall confidence in assessing and managing acutely unwell residents 6 months after the implementation of the REDI and CHAT (p= 0.003 and p= 0.006, respectively). Baseline Confidence in Assessment Scale and Confidence in Management Scale scores differed significantly 6 months following the implementation of the REDI and CHAT tools (p< 0.001). There was improvement across all surveyed communication domains. Preliminary data suggested that the two structured tools are effective in increasing confidence in the assessment, management and communication of acutely unwell residents for nursing and care staff working in RACFs.

Good Communication During Clinical Handovers: The Students' Perspective.

Good Communication During Clinical Handovers: The Students' Perspective.

A qualitative analysis of adding kindness into the ISBAR handover tool.

The COVID pandemic has highlighted the stresses experienced by our medical workforce, with worldwide publications attesting to high rates of depression, anxiety and burnout, particularly in junior doctors. Many studies focus on reporting on the prevalence of mental health issues, but not many report on interventional strategies. One of the most stressful interactions in the day of a junior doctor is the medical handover. The incorporation of kindness into clinical handover has coined the term 'KISBAR' to underline the importance of delivering handover in a kind manner. The aim is to analyse the efficacy of a novel intervention by introducing an emotional support representative to participate in the morning labour ward handover. We undertook an ethnographic constructivist qualitative research project in a tertiary hospital in Perth, Western Australia, using focus groups to explore the views of junior medical staff on the KISBAR handover tool in the specific context of labour ward handover. Fifty per cent of the total junior doctors from the hospital participated in this study. Four dominant themes arose from analysis of the focus group discussions: (i) inherent stress experienced by junior doctors during the labour ward handover process, (ii) support strategies for junior doctors during labour ward handover; (iii) role modelling and the hidden curriculum aspects of communication from senior doctors at labour ward handover; and (iv) benefit of having an emotional support person present for labour ward handover. Our study confirmed the benefit of having an emotional support person present at labour ward handover: improved perception of safety and an environment that junior doctors found to be supportive. This is a novel and reproducible interventional strategy which is applicable to various obstetric units around Australia.

Perioperative management of pressure injury: a best practice implementation project.

This project aimed to set up a control mechanism for the prevention of pressure injuries during surgery. Structured and comprehensive risk assessment is effective in identifying individuals at risk for pressure injuries. The subsequent use of proper positioning aids (modern gel-filled positioning aids used to position the head and limbs: floating limb concept) reduces the incidence of surgery-related pressure injuries. The best practice implementation project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in local healthcare practice. The study was carried out from January 2020 to February 2021 at the private clinic of aesthetic surgery (Brno, Czech Republic). A baseline audit involving 27 patients was undertaken and measured against six best practice recommendations. This step was followed by the implementation of targeted strategies and finally, a postimplementation follow-up audit was conducted. The baseline audit results showed significant deficits between current practice and best practice in all but two criteria. Barriers to implementation of nursing clinical handover best practice criteria were identified by the project team and an education strategy was implemented, documentation for recording possible risks of pressure injuries was created, and new positioning aids were purchased and introduced into clinical practice. There were significantly improved outcomes across all best practice criteria in the follow-up audit. Clinical audits were proved to promote best practice in healthcare. Focused education, provision, and use of relevant tools and aids can have an immediate and positive impact on clinical practice. Future audits are planned to ensure the sustainability of practice changes.

Danger in discharge summaries: abbreviations create confusion for both author and recipient.

The transition from hospital inpatient care to medical care in the community is a high-risk period for adverse events. Inadequate communication, including low-quality or unavailable discharge summaries, has been shown to impact patient care. To assess use of abbreviations in clinical handover documents from inpatient hospital teams to general practitioners (GP), and the interpretation of these abbreviations by GP and hospital-based junior doctors. This is a retrospective audit of 802 discharge summaries completed during a 1-week period in 2017 by a Queensland regional health service. GP and local junior doctors then attempted interpretation of 20 relevant abbreviations. A total of 99% (794) discharge summaries included abbreviations. A total of 1612 different abbreviations was used on 16 327 occasions. The median number of abbreviations per discharge summary was 17 (range 0-86). A total of 254 GP and 62 junior doctors responded to a survey, which found that no abbreviation was interpreted the same by all respondents. GP and junior doctors were unable to offer any interpretation in 17.9% and 15.2% of cases respectively. GP offered a greater range of interpretations than junior doctors, with a median of 9 and 3 different interpretations per abbreviation respectively. A total of 94% (239) of GP felt that the use of abbreviations in discharge summaries had the potential to impact patient care. A total of 152 (60%) GP felt that time spent clarifying abbreviations in discharge summaries could be excessive. Abbreviations are often used in discharge summaries, yet poorly understood. This has the potential to impact patient care in the transition period after hospitalisation.

Improving Clinical Documentation Compliance Pre-Gastrointestinal Endoscopy Procedures Through the Use of an Endoscopy Checklist.

Production pressure in endoscopy units, to avoid procedural delays, can lead to documentation gaps that pose a patient safety risk. Fast-paced, high-volume endoscopy units within a 673-bed academic medical center, incomplete and illegible documentation were identified during a 2018 Joint Commission survey. Pre-procedure safety checklists help ensure accurate clinical handovers. Checklists promote team communication that includes the patient to have complete and relevant information to perform a safe procedure and speak up to identify discrepancies. An endoscopy-specific safety checklist was used by the procedural team immediately pre-procedure. This quality improvement project used Plan Do Study Act cycles to incorporate changes suggested by users. Chart audits were conducted pre- and post-pilot. The results showed significant improvements in physician documentation completeness and legibility, suggesting the checklist prompted clarification of documentation and communication between the nurse and the physician. Nursing assessment saw a 27.1% improvement, suggesting clarification of clinical handover between the admitting and procedural nurses. Improved communication was perceived by staff. This project showed how a standardized tool to promote team communication and clarification of discrepancies pre-procedure can contribute to prevention of errors.

Teaching Clinical Handover by Clinical Reasoning.

Teaching Clinical Handover by Clinical Reasoning.

Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol

BackgroundNurses play a major role in patient safety. Poor nursing assessment and communication practices are associated with higher incidence of the adverse events of undetected deterioration, falls, and pressure injuries. Despite widespread adoption of patient safety systems, occurrence of these events continues. AimTo implement and evaluate the feasibility and effectiveness of an organisational ward-level intervention to facilitate comprehensive systematic assessment and improved communication in clinical handover to reduce medical emergency team calls; unplanned Intensive Care Unit admissions; falls; and pressure injuries. DesignA stepped-wedge cluster randomised trial sequentially implemented over 12 months. MethodsEvidence-based implementation strategies will be employed to support implementation of an intervention focusing on comprehensive systematic patient assessment and improved nurse bedside clinical handover and multidisciplinary communication involving the patient. These are – intervention tailoring to individual wards through barrier and enabler identification; action plans; education; clinical champions; outreach visits; facilitation; clinician engagement; and reminders. Primary outcome measures will be a composite of Medical Emergency Team calls and unplanned intensive care unit admissions for deterioration. Secondary outcomes will be all categories of inpatient falls; stage 2–4 pressure injuries; nurse-reported perceptions of: teamwork; safety culture, and engagement; and patient-reported experience measures of receiving safe and patient-centred care. An a priori process evaluation will determine factors influencing intervention uptake and inform strategies for future upscale and spread. DiscussionThis feasibility trial will provide evidence regarding the use of systematic comprehensive patient assessment, combined with clinical handover re-design involving patients, to reduce clinical deterioration, falls and pressure injuries.

Improving the clinical handover of patients discharged from the intensive care unit to inpatient wards at a district general hospital: a quality improvement project

Improving the clinical handover of patients discharged from the intensive care unit to inpatient wards at a district general hospital: a quality improvement project

Clinical Hand Over: A neglected domain in our Health Care

Clinical handover or shift handover refers to “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis1. It is considered a vital and valuable affair in healthcare pathway in a clinical practice. In fact, it is a complex domain in advanced communication skills in medical sciences, which is being recognized increasingly to enhance patient care and safety. It involves the effective communication of high‑quality clinical information while transferring the patients care responsibility to other person or clinical team or at change of shift or any time or transferring to another hospital2. In clinical practice, if relevant clinical information’s were not shared timely and accurately, may results delay in diagnosis, delayed or inappropriate treatment, any adverse events or omission of care. To overcome this, an effective and accurate clinical handover is very crucial in promoting health care continuity and patient safety3. The World Health Organization, Association of American Medical Colleges and Joint Commission4 has also recognized the importance and emphasize the need to improve handovers quality. These organizations have declared it a core entrustable professional activity and issued a mandate by emphasizing the health care institutes to standardize the handovers process and incorporate handover training of their employees in order to improve the consistency and minimize the vulnerability to errors5,6. It is estimated that in USA over 300 million, in Australia more than 40 million and in UK above 100 million clinical handovers are conducted each year7. Arguably, this number is making this practice most frequent and significant process in communication between clinicians and paramedical staff in providing safe patient care. Due to increasing emphasis on person-centered medical care all over the world, a change from traditional to structured handover’s practices is being developed. Literature is now favoring the use of a structured handover framework and advocates patient’s placement at the centre of their care. It is purely a communicative event which can only be achieved through linguistic exchange, by clinicians or paramedics discussion and writing which is conducted between outgoing and oncoming staff at the time of shift change or during patient hand over. This acts a key tool in ensuring the continuity of patient’s information’s which in turns are very important for the continuity of care8. For better outcome technological support like templates, internet, computers, soft wares etc are also used to enhance the effectiveness and safety of this process5,7. To meet the colleague, organizational and patients’ requirements, the staff and doctors should be made aware about its importance and trained to deliver an effective handover9,10. It is also imperative that doctors and paramedical staff should identify any potential barriers encountered during handovers to effectively address these obstacles. As a part of Good Medical Practice, it is recommended and expected that all health professionals should learn and practice excellent handover skills, in order to ensure effective communication between each other of important patients’ clinical information, to ensure patient safety and enable inter-professional collaboration10. It has been reported in literature that the poorly conducted shift handovers, most likely threaten patient’s quality of care, safety and continuity of care2.

Exploring nurses' perceptions of clinical handover in regional health care facilities: A exploratoryqualitative study.

This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models. Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context. This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility. Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs. This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting. Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse.