Effective Handover Research Articles

Clinical Handover among Physicians: A Survey in a North Eastern Italian Academic Hospital

Transferring essential information and responsibility for patient care from one health care provider to another is an integral component of patient safety in a hospital. This study aims to collect physician interests and needs about handover before introduction of a standardized tool in a North Eastern Italian Academic Hospital (AH). From October 2014 to December 2014 all physicians working in the AH were asked to fill a web-based questionnaire concerning currently adopted methods to clinical handover and their perception on its. Response rate was 10.5% (90/853). 63.3% (57/90) of physicians showed maximal agreement with the statement “communication failures are related to adverse events” and 40% (36/90) of them completely agreed that “improving handover makes work safer”. Among actually used handover methods (total answers: 157), verbal communication was referred 45.2% times, written notes 26.1%, electronic supports 21.7%. The most frequently reported obstacles to an effective handover (107 answers) were interruptions (27.1%), absence of hospital written protocols (25.2%) and colleague’s inability to provide further information when required (17.7%). Respondents interested to test a new handover procedure were 48.9% (44/90). The low response rate and the fact that only half of respondents were interested in experimenting a new procedure stress the little relevance given by physicians to handover as a key process for patient safety. Furthermore, hazardous methods of transferring information such as verbal communication and non-structured text, combined with referred handover obstacles, suggest the necessity of developing a hospital policy for clinical handover among physicians.

Implementing an electronic patient handover system.

Clear communication among health-care teams is paramount for safe patient care and effective handover. Advances in information technology have led to an increased use of electronic systems within modern health care. This quality improvement project introduced an electronic patient handover system that was intended to improve the accuracy of patient handover lists and be readily available to all members of the health-care team. A quality improvement project was undertaken to assess the effect of introducing an electronic patient handover system on maintenance workload and list accuracy. List errors were common before the introduction of the electronic patient handover system, commonly patient location or a patient being incorrectly omitted from the list. These errors decreased significantly after the introduction of the electronic system (P<0.005 and 0.04 respectively). The workload associated with its maintenance also decreased (P<0.005) because many data fields were pre-populated by the software. This resulted in fewer instances of patients being missed on ward rounds (P<0.04). Through modifying existing information technology infrastructure, a centrally maintained, widely accessible electronic handover system was introduced. This reduced the workload associated with maintaining handover lists and the rate of errors.

Optimizing postoperative handover to the intensive care unit at a tertiary centre.

Comprehensive handover of patients transferred from operating theatre to the intensive care unit is crucial in ensuring ongoing quality and safety of care. Handover in this setting poses unique challenges, yet few studies have considered or tested approaches to improve the process. A quality improvement project was undertaken to assess and improve the quality of information transfer during the handover of postoperative patients to the general intensive care unit at a tertiary centre. This quality improvement project considered all postoperative patients aged 18 years and over, using the plan-do-study-act (PDSA) approach, over a 3-month period in 2015. Baseline audit encompassing intraoperative details (allergies, grade of intubation, estimated blood loss, difficulties and complications) and the postoperative plan (analgesia, thromboprophylaxis, antibiotics and their proposed duration and nutrition) was undertaken to define the extent of the clinical problem. Changes were implemented over two cycles, centred around a novel checklist, and the transfer of information was re-audited after each cycle. Baseline audit (n=30) revealed a need for improvement across all domains. In PDSA cycle 1, a novel checklist was introduced which led to global improvement across all areas with performance exceeding 70% in all but three out of nine domains (n=33). Engaging key stakeholders (PDSA cycle 2) resulted in overall improvement from baseline but decreased performance in just under half of domains in comparison to PDSA cycle 1 (n=31). Successful implementation of a series of simple interventions resulted in more effective handover of postoperative patients admitted to an intensive care unit. Sustained long-term improvement is a major challenge and can only be achieved with the global engagement of all staff and incorporation of changes into routine clinical practice.

Intelligent Handover Scheme for Drone Using Fuzzy Inference Systems

Many network technologies, including cellular, Wifi, and WiMAX, coexist in wireless networks. With the increasing demand on mobility-based network services on account of the popularity of smart devices, users expect network environments in which they can readily access the Internet at any time and place. An effective handover decision is necessary to provide users with continued services while they are mobile. Existing studies on handover have strived to improve the mobility of the object moving and communicating on the ground. However, a traditional handover decision is not suitable for a drone moving and communicating in 3-D space. Therefore, in this paper, parameters that represent the characteristics of drones communicating within 3-D space are defined, including speed limit and coverage. Using these parameters as input variables, a fuzzy inference method for the handover decision is proposed. A fuzzy inference system is composed of four steps. First, terminal-related information is analyzed to select the factors that can affect the drone handover decision. Second, the input data values are converted into membership functions. Third, the reasoning rules for the handover decision are designed and applied. Finally, the handover is decided by considering the current information of the drone. The computation of the number of handover decisions has shown that considering the terminal-related parameters and the network-related parameters has a positive effect on the handover decision.

Nurses’ perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study

Background: Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care. Aim: To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore. Methodology: An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis. Results: Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients. Conclusion: This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.

Dealing Handover with Publish/Subscribe Middleware for Vehicular Networks: Modeling and Performance Analysis

Because of the high mobility of nodes and of the low node density, the vehicular networks is sparse, partitioned into several areas, and thus characterized by an intermittent connectivity. So, in such networks, the mobility management, providing an effective handover and the delivery of the messages with low loss, is a real challenge. The content based publish/subscribe middleware has proven its efficiency for messages delivery in networks with fixed clients. However, by its decoupling in space, time and flow content based, publish/subscribe becomes a good solution for mobile wireless environments which are characterized by frequent and unpredictable disconnections due to clients mobility or weak wireless channel. Yet, in such environments it is essential that, when clients disconnect from an attachment point and reconnect to another, they can receive the messages that were published after they disconnected. This paper propose a content-based publish/subscribe middleware as data dissemination and disconnections management solution, based on the OMG's Data Distribution Service (DDS), which performs effective handover and reroutes undelivered events with low loss rate. For performance evaluation, the paper proposal implements a content based publish/subscribe middleware prototype first to analyze the system and then to demonstrate, through these evaluations, that the publication/subscription system allows to adapt itself quickly to the frequent disconnections. Then it will be demonstrated that the handover management protocol can improve effectively the performances of the system.

Qatar ambulance service and Hamad General Hospital Emergency Department staff's perception of current patient handover practice

Background: The handover process is meant to ensure patient safety and maintain continuity of care through endorsement of critical patient information. This study evaluates staff's perceptions about the current patient handover process effectiveness between Ambulance Service (AS) and Emergency Department (ED) clinicians. It may help identify barriers and contributing factors to an effective patient handover. Methods: An electronic questionnaire was circulated to all ED doctors/nurses and AS staff (Estimated N = 1,000). 400 questionnaires were completed of which 92 did not meet the inclusion criteria. Respondents were 43% AS staff, 29% ED nurses, and 28% ED doctors. A 4-point Likert scale (1 = strongly disagree-4 = strongly agree) was used. The mean was calculated for every variable to determine each group perception. One-way ANOVA tested the relationship between demographics and perceptions’ variables. Results: Although 62% of respondents believe the current handover process is safe and 65% believe AS staff report all critical information, 70% of respondents think that it causes AS/ED staff conflicts, and 72% believe the current handover process needs changing. ANOVA test revealed significant differences in the mean between study groups’ handover safety perceptions. Interestingly, ED nurses expressed more safety concern (2.43) than ED doctors (2.58) and AS staff (2.82) with p-value &lt; 0.05. The main perceived barriers to effective handover were: Lack of handover protocol (89%); Lack of a standardized handover tool (89%); Fragmented communication (85%); and Frequent interruptions (82%). 93% of the respondents believe the use of a standardized handover tool will improve the patient handover process despite 67% of them not knowing any standardized handover tool. Conclusion: The lack of handover protocol and a standardized tool leads to significant variation and is a patient safety concern due to potential loss of critical information. We believe that a mutually agreed standardized handover tool such as ISBAR would reduce handover variation and ensure quality.

Best of both worlds: combining evidence with local context to develop a nursing shift handover blueprint.

Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, local context is considered of equal importance to improve the handover process. Our objective was to determine what recommendations on standardized shift handover nurses make, if we combine evidence from the literature with the local context of the nurses. A RAND-modified Delphi consensus process that combines evidence from systematic reviews with expert opinion of local nurses and an evaluation of the consensus process with a survey. One academic medical center in the Netherlands. Twentynurses from surgical, medical, neurological, psychiatric, cardiology, children's and gynecology departments. Four systematic reviews on nursing handover were included to compose provisional recommendations on how, what, where and the preconditions of shift handover. Nurses reached consensus on a final set of 18 recommendations for a nursing shift handover blueprint: how (1 recommendation), what (12 recommendations), where (3 recommendations) and the preconditions (2 recommendations), which were structured with the mnemonic NURSEPASS. The nurses assessed the method as an effective approach to develop a local blueprint. Evidence-based consensus is a feasible method to combine evidence from the literature with local context. We anticipate that implementation of the resulting tailored blueprint for nursing shift handover will be facilitated due to the method used. Through evaluation of its effectiveness, we intend to add to the body of evidence on development and implementation of effective nursing handover, which is an essential link for continuity and safety of care.

The Intern Handover: the Gap Between Expectations and Performance

The effective resident handover during transitions of patient care is a skill that is identified as one of the entrustable professional activities (EPAs) required for entering residency training. This study describes the results of an objective structured clinical exam (OSCE) station designed to assess interns’ skills in writing a handover of a standardized patient scenario. In 2015, 130 entering interns, representative of 47 of 125 allopathic medical schools, from 13 residency programs at the University of Florida participated in an OSCE that included a written handover station. A nine-item checklist was used to assess performance of interns on the station. Scores on the station ranged from 11.1 % (1 of 9 items correct) to 88.9 % (8 of 9 items correct). While there were no significant differences in handover performance between males and females or between surgical and non-surgical specialties, interns who graduated from top-50 medical schools performed better than graduates from the medical schools not ranked in the top 50. However, the overall failure rate on the handover station was 73 %. This study demonstrates that, despite the fact that the handover is an identified EPA, our interns did not enter residency with the skillset required to successfully demonstrate the required key components of a written patient handover. This demonstrates an undergraduate curricular need for the newly identified EPA that must be addressed.

Safe and effective nursing shift handover with NURSEPASS: An interrupted time series

AimImplementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover. MethodsA mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process. ResultsWe observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated. ConclusionUse of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed.

Clinical audit: Effective handover of critically ill patients in intensive care units between the shifts by the medical and nursing officers.

Hand over is the process of transferring clinical data between health care professionals. Interruption to the continuity of care can take place during handover and result in poor patient outcome. The aim of this audit was to find out whether the handover practice between shifts in the Intensive care unit (ICU) is safe and effective. Data was collected by a self-administered questionnaire which was distributed among nursing and medical officers who were selected by convenience sampling of ICU’s at the National Hospital of Sri Lanka (NHSL). It was identified that there are multiple deficiencies in the current hand over practice and need introduction of standardized hand over technique to our ICU’s.

Reporting Achievement of Medical Student Milestones to Residency Program Directors: An Educational Handover.

Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear-as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions.

Clinical handover practices in maternity services in Ireland: A qualitative descriptive study

Objectivethe objective was to examine and describe clinical handover practices in Irish maternity services. Designthe study design incorporated interviews and focus group discussions with a purposive sample of healthcare practitioners working in Irish maternity services. Settingfive maternity hospitals and fourteen co-located maternity units. Participantsmidwives, obstetricians and other healthcare professionals, specifically physiotherapists and radiologists, midwifery students and health care assistants working in maternity services. Findingsthe study participants provided nuanced and differentiated accounts of clinical handover practices, which indicated a general absence of formal policy and training on clinical handover and the practice of midwifery and medical teams holding separate clinical handovers based on their separate, respective needs for transferring information and clinical responsibility. Participants spoke of barriers to effective clinical handover, including unsuitable environments, lack of dedicated time and fatigue during duty shift clinical handover, lack of supportive information technology (IT) infrastructure, and resistance of some staff to the adoption of new technologies to support clinical handover. Key conclusionswhether internal and external to clinical handover events, the barriers to effective clinical handover represent threats to patient safety and quality of care, since effective clinical handover is essential to the provision of safe quality care. Implications for practiceclear and effective communication between collaborating professionals within maternity teams is essential.

Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform

Objectives: Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. Methods: During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Results: Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. Conclusion: The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.

Handover: The Fragile Lines of Communication

Handovers have been increasingly recognized as an important determinant of patient safety and quality of care. Changes in patterns of physician and resident work hours have increased the importance of safe handover. The current review summarizes previous literature on deficiencies in current handover practices, consequences of suboptimal handover, and barriers to effective handover. This review concludes by summarizing results of studies that used education, standardization, technology, and bundled interventions to improve handover.

Improving Weekend Out Of hours Surgical Handover (WOOSH)

An effective surgical handover is imperative to optimise patient care and safety, whilst ensuring progression of clinical management and the delivery of an efficient service. The introduction of full-shift working,...

Establishing an effective surgical handover process – Senior nurse led enforcement using a checklist of standards work

Establishing an effective surgical handover process – Senior nurse led enforcement using a checklist of standards work

Achieving an effective handover is the duty of every doctor – Is general surgical handover in a district general hospital compliant with the royal college of surgeons of england guidelines?

Achieving an effective handover is the duty of every doctor – Is general surgical handover in a district general hospital compliant with the royal college of surgeons of england guidelines?

Building a novel pediatric intensive care iPad handover aid for residents.

There is no consensus on how effective patient handover in the pediatric intensive care unit should occur. Complex patients with rapidly moving clinical trajectories are difficult to summarize and comprehend. We aimed to redesign our current handover instrument to encourage higher-level cognitive interactions, questioning and understanding for pediatric residents. Through an iterative process with five pediatric intensive care unit intensivists, the current hardcopy handover tool was reviewed and compared to other formats published in medical and non-medical domains. Several handover formats on the iPad were created and proposed, but continual feedback from intensive care unit physicians led to a selection, and further revisions were made. A mock handover with completed data fields allowed pediatric residents to provide the final feedback in both a semi-structured group review and a survey with responses on a 1-5 Likert scale (1 = strongly disagree; 2 = disagree; 3 = neither agree or disagree; 4 = agree; 5 = strongly agree). A novel two-axis data grid combining the 'systems' and 'problem list' approach was developed, with read back prompts, and off the shelf applications such as "burn notices". Residents found ease with the organizational format (4.0 ± 0.67 Likert scale response) and the transition to the iPad device (4.3 ± 0.67). Improving physician handovers may be achieved efficiently and economically through physician led iterative processes. Pediatric residents were at ease when the novel handover was combined with newer iPad technologies and applications.

Passing the baton: a systems approach to providing 24/7 medical care in a hospital

Handover is defined as ‘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 basis’. Owing to a changing NHS, increasing numbers of admissions and changes to structures of medical teams since EWTR and MMC in the UK, effective handover to incoming teams is essential to providing high-quality acute and out-of-hours care, as highlighted by …