Handover Of Patient Information Research Articles

Patient information handover between care providers

The handover of patient information between care providers is a big challenge. Important information is easily missed or the interpretation may differ among care providers. Structured transfer methods are used in the hospital to avoid this.
 In the hospital AZ Sint-Lucas (Ghent; Belgium), we have implemented three different methods based on literature. First, during the handover we use the SBAR-method. Whit this method, patient information about ‘Situation-Background-Assessment-Recommendation’ is given to each other. The Second, in line with the SBAR is the ‘Identification-Situation-Background-Assessment-Recommendation-Readback’ (ISBARR) method we use for the telephone communication between nurses and physicians. So there is extra focus on the ‘identification’ of the care provider and ‘readback’ of the physician orders. As a third method, ‘Bedside shift reporting’ (BSR) is used on the nurse departments in the hospital. This means that the handover is carried out in the room of the patient which improves patient participation on the nursing wards. In general, it gives patients more chance to interact with nurses, providing them more notice of the information that is handed over. During the patient intake, the BSR method is explained to the patient and his preference for BSR is noted in the patient file.
 Several months we did observations on the nursing wards during the handover moments from the early to the late shifts. The focus of these observations was on the performance of BSR and the use of the SBAR method. After the observations feedback was given immediately to the nurses and findings were documented in a report. These observations indicated which wards used the methods on a daily basis and what the points of attention were, to plan additional support or training.
 For physicians, file scans are used to evaluate whether they consistently create tour notes. There is a noticeable increase of the fill-in rate since the implementation of the central patient file across the different specialties. The central patient file was enrolled in several stages over the specialties from 2017 until 2019. In 2021 the integrated patient file over the different discipline was introduced, where patient information is shared between the different care providers. In the integrated patient file, the component 'multidisciplinary communication' was positively received. In this component findings about the patient or questions addressed to the physician can be noted. Physicians can also note certain instructions aimed at the nurse in this component. The findings in this component are often further discusses verbally between the responsible nurse and the attending physician.
 In sum, we can conclude that a good documentation in the integrated patient file and the use of different methods like SBAR can help us to provide a structured patient handover, reducing the risk that crucial information will be lost during handover. Nevertheless, further monitoring is needed.

Improving the Medical and Surgical Out-of-Hours Handover at a Hospital in Regional New South Wales, Australia.

Introduction: Effective handover between shifts is widely accepted as essential for continuity of care and patient safety. Problems with out-of-hours handover were identified at our hospital, having come to light following attendance at handover meetings by the authors.Methods: Consultation of junior doctors was performed to identify issues with the out-of-hours handover and a baseline audit was conducted to objectively assess handover practice. Local guidelines were used to create a handover tool, which was subsequently implemented and assessed via multiple PDSA (plan, do, study, and act) cycles. In addition, registrar education was undertaken. Concurrently, meetings with senior clinicians and managers were held to address wider issues including venue, intensive care registrar attendance, emergency call procedures, and implementation of an electronic handover tool.Results: Junior doctor consultation and baseline audit identified failings in handover. Following our intervention, improvements were demonstrated in the handover of patient information, including diagnosis (50% increase), investigations (76% increase), and plan (33% increase). Doctor attendance and punctuality also improved, along with a more punctual start time and reduced handover duration of five minutes on average.Conclusion: Bringing structure and leadership to an informal and inconsistent handover system using simple and well-defined methods can improve the quality and consistency of handover. The sustainability of the intervention was demonstrated with continued improvements seen in a subsequent cycle.

The impact of patient safety culture on handover in rural health facilities

BackgroundEffective handover is crucial for patient safety. Rural health care organisations have particular challenges in relation to handover of information, placing them at higher risk of adverse events. Few studies have examined the relationship between handover and patient safety in rural contexts, particularly in Australia. This study aimed to explore the effect of handover on overall perceptions of patient safety and the effect of other patient safety dimensions on handover in a rural Australian setting.MethodsA cross-sectional online survey using The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was implemented across six rural Local Health Districts in NSW, Australia and resulted in 1587 respondents. Hierarchical multiple linear regression analysis was conducted to account for the nested nature of the data. Models were developed to assess the effect of handover on patient safety perceptions, and the effect of other patient safety culture composites on handover variables. Open-ended questions about patient safety were inductively analyzed for themes. Quotes from the handover theme are presented.ResultsAll models were significant overall (p < .001), with explanatory powers ranging from 29 to 48%. Within rural health settings, effective handover is significantly related to patient safety perceptions (R2 = .29). A strong teamwork culture and management support culture was found to enhance effective handover of patient information (R2 = .47), and effective handover of personal responsibility (R2 = .37). A strong teamwork, management support, and open communication culture enhances handover of department accountability (R2 = .41).Despite the implementation of standardised communication tools and frameworks for handover, patient safety is compromised by inadequate coordination, poor or absent documentation between departments, between other health care agencies and in transfer of care from acute facilities to primary/community care.ConclusionApproaches to handover need to consider the particular challenges associated with rurality and strengthening elements found to be associated with increased safety, such as a strong teamwork and management culture and good reporting practices. Research is required to examine how communication at transition of care, particularly between facilities, is conducted and ways in which to enhance patients’ and families’ participation.

Weekend surgical handover enhances early management of acute clinical changes using a red flag system.

Recent implementation of the European Working Time Directive in Ireland has resulted in a change from thetraditional model of patient care to a system characterised by shift work among clinicians. Effective handover ofpatient information is essential for transfer of responsibility between clinicians and maintaining continuity of care. The weekend has been identified as a particularly vulnerable transition of patient care. Our study aims to determine if implementing a formal face-to-face handover accompanied by an electronictemplate in our surgical department can improve the number of adverse events reported back to the primary teamafter a weekend on call. Data was collected over 12 weekends between February and May 2016. A list of adverseevents was established, and during an initial observation period of 6 weeks, we documented the number of adverseevents that were informally handed over. A 6-week intervention was then performed, involving a formal face-to-facehandover on Monday morning supported by an electronic patient census using a red-flag system to highlightpatients who experienced an adverse event over the weekend. Our results showed the mean number of adverse events recorded pre-intervention was 3.17±0.6 over the 6-week period. Following the introduction of weekend face-to-face handover, there was 147% increase in the number of adverse events recorded with a mean of 7.83±1.2. The introduction of a formal face-to-face weekend handover with a red-flag system resulted in increased reporting of patient adverse events, allowing earlier recognition and management.

Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care.

To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George's Hospital Cardiothoracic Intensive Care Unit. For each patient's handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0-2. Zero if no information in that category was transferred, one if the information was partially transferred and two if all relevant information was transferred. Each patient's handover received a score from 0 to 10 and thus, each cycle a total score of 0-500. Following the implementation of the Identification, Situation, Background, Assessment, Recommendations handover tool in our Intensive Care Unit in Cycle 2, we re-observed the handover process for another 50 consecutive patients hence, completing the audit cycle. There was a significant difference between the total scores from Cycle 1 and 2 (263/500 versus 457/500, p < 0.001). The median handover score for Cycle 1 was 5/10 (interquartile range 4-6). The median handover score for Cycle 2 was 9/10 (interquartile range 9-10). Patient handover scores increased significantly between Cycle 1 and 2, U = 13.5, p < 0.001. The introduction of a standardised handover template (Identification, Situation, Background, Assessment, Recommendations tool) has improved the quality and safety of the doctor-to-doctor handover of patient information in our Intensive Care Unit.

Empowering nurses through action research for developing a new nursing handover program in a pediatric ward in Iran

This study aimed at developing a new nursing handover program in pediatric wards in Iran through action research. Nursing handover is the handover of patient information among nurses between shifts. The participants, including 12 nurses, 2 assistants, a head nurse, and academic researchers as facilitators, worked through two cycles of reflection and action for change over a period of 20 months from 2012 to 2014. The data were collected and analyzed using the concurrent mixed method. Reflection on actions in two cycles resulted in designing and implementing action plans for change, learning in both participants and facilitators, and improvement in nurses' satisfaction with the new nursing handover program. Furthermore, the quantitative data showed a significant decrease in time and cost of nursing handover. This study resulted in the participants' deep understanding about the principles of nursing handover in real world, applicable knowledge through action for change, and reflection on it. Finally, the nurses could establish the foundation of sustainable nursing handover successfully.

Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.

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Introduction: Preventable deaths due to error in trauma patients with otherwise survivable injuries account for up to 10% of fatalities in Level I trauma centers. The root cause of 67% of the Joint Commission sentinel events is communication errors, including those generated during the handover of patient information between in-hospital units. Hypothesis: The objective was to identify challenges in the handover of trauma patients from the Emergency Department (ED) to the Intensive Care Unit (ICU) from the perspective of Trauma Team Leaders (TTLs) in a Canadian Level I Trauma Center. Methods: Qualitative, semi-structured interviews were conducted with multi-disciplinary TTLs exploring themes related to the structure, process and outcome of handover. Thematic analysis was undertaken using Grounded Theory methodology. Results: Recurrent themes emerged demonstrating challenges in the handover of the trauma patient from the ED to the ICU. Specifically, handover lacked a standardized structure. Responsibility for handover initiation was poorly defined. The process was also felt to be haphazard with multiple distracting forces. These included absentee receiving personnel to parallel handovers performed in a noisy environment. Outcomes were felt to be worse for patient safety as critical, clinical information was lost with the lack of a standardized structure for handover. Multi-disciplinary TTLs placed different importance on specific clinical details during handover. Standardization processes analogous to the ‘surgical safety checklist’ were welcomed as potential solutions. Conclusions: The handover of clinical information of critically injured trauma patients is complex and lacks standardization. Checklists should be utilized as a quality improvement tool to improve communication between the ED and ICU teams during trauma patient handover.

Promoters and barriers in hospital team communication. A focus group study

PurposePoor teamwork and communication in healthcare teams have been correlated to adverse events and higher patient morbidity and mortality. However, detailed insight into the link between team communication and medical error is still lacking. The objective of this study is to identify the common characteristics of team communication among multiprofessional teams at four Danish acute care university hospitals.MethodFour focus group interviews with multiprofessional hospital teams (N = 24).ResultsCommunication is particularly vulnerable during handover of patient information between shifts or units, when a team has to establish skills and roles during teamwork and when staff has to await and combine information from different chart systems. Established frameworks for communication, mutual knowledge, ease of speaking up, experience in getting the message through, and focus on teamwork and communication promote safe information exchange. Lack of standard assignments and procedures, a flat hierarchy that leaves responsibility unclear, different agendas for the treatment of the patient, interruptions, and multitasking, inhibit safe information exchange.ConclusionPower distance, team structure, and hospital organization influence team communication and vary between settings and national cultures. These factors must be accounted for before developing or adapting team communication interventions to improve patient safety.

A national survey of obstetric anaesthetic handovers*

The handover of patient information between shifts enables continuity of care and increases patient safety. We surveyed UK practice during handovers in obstetric anaesthesia. A questionnaire was sent to 239 lead consultant obstetric anaesthetists to record routine practice in their unit and individual opinion about handover procedures. Responses were received from 168 anaesthetists, a 70% response rate. Handover policies were available in 10% of units. Most (76%) responding units had an allocated time for handover. In most units (76%), the duration of handover was reported as being < 15 min but the actual duration and depth of any discussion involved were not specified. Handovers were rarely documented in writing (7%). Consultant anaesthetists were most likely to be present at the morning handover and few handovers were multidisciplinary. Four percent of units reported critical incidents following inadequate handovers in the past 12 months. We identify features in handover procedures that could be improved.