Handover Situations Research Articles

Modeling and Analysis of V2I Links for the Handover Situations at mmWave Band

Modeling and Analysis of V2I Links for the Handover Situations at mmWave Band

Midwives’ experiences with a safe childbirth checklist: A grounded theory study

ObjectiveThe aim of this study was to explore midwives’ experiences with a safe childbirth checklist used in handover situations from birth to hospital discharge. Quality of care and patient safety is highly recognised and a priority within health services globally. In handover situations, checklists have proven to reduce unwanted variation by standardising processes, which in turn contribute to increased quality of care. To improve the quality of care, a safe childbirth checklist was implemented at a large maternity hospital in Norway. DesignWe conducted a Glaserian grounded theory (GT) study. Setting and participantsA total of 16 midwives were included. We included three midwives in one focus group and conducted 13 individual interviews. Years of experience as midwives ranged from one to 30 years. All included midwives worked in a large maternity hospital in Norway. FindingsThe main concern faced by the midwives who used the checklist included no common understanding of the purpose of the checklist nor consensus on how to use the checklist. The generated grounded theory, individualistic interpretation of the checklist, involved the following three strategies that all seemed to explain how the midwives solved their main concern: 1) not questioning the checklist, 2) constantly evaluating the checklist, and 3) distancing oneself from the checklist. Experiencing an unfortunate event concerning the healthcare of both mother or newborn was a condition that could alter the midwives understanding and use of the checklist. Key conclusionsThe findings in this study showed that a general lack of common understanding and consensus on the rationale for implementing a safe childbirth checklist led to variations between midwives in how and whether the checklist was used. The safe childbirth checklist was described as long and detailed. It was not necessarily the midwife who was expected to sign the checklist who had carried out the tasks signed for. To ensure patient safety, recommendations for future practice include securing that separate sections of a safe childbirth checklist are limited to a specific time-point and midwife. Implications for practiceFindings emphasise the importance of implementation strategies supervised by the leaders of the healthcare services. Further research should explore the understanding of organisational and cultural context when implementing a safe childbirth checklist to clinical practice.

Design of Blockchain-Based Lightweight V2I Handover Authentication Protocol for VANET

Connected vehicle means providing different services, such as advanced driver-assistance systems (ADAS) from vehicles connected to the network. Vehicular ad-hoc networks (VANETs) can support vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications to realize connected vehicle. In VANETs, secure communication must be ensured, as otherwise it can lead to traffic accidents and human injuries. Recently, many studies on V2I authentication have been conducted to guarantee the security of V2I communications. However, recent V2I authentication protocols do not consider the handover situation, and it causes unnecessary computations. As vehicles have limited computing resources, unnecessary computation can lead to overload to the vehicles. In recent years, blockchain-based VANET is an active field of research because it can provide decentralization, data integrity and transparency. Using the strength of the blockchain technology, we design a blockchain-based handover authentication protocol for VANETs. In the proposed protocol, vehicles only perform lightweight computations in handover situations for efficiency of the network. We also conduct the formal analysis such as Burrows–Abadi–Needham (BAN) logic, Real-Or-Random (ROR) oracle model, and Automated Validation of Internet Security Protocols and Applications (AVISPA) simulation to the proposed protocol. We simulate the proposed protocol using network simulator 3 (NS-3) to verify that the proposed protocol is practical. Finally, we compare the computational cost and security features of the proposed protocol with existing protocols to show that the proposed protocol is more secure and efficient.

Reduced autonomy workspace (RAW)\u2014an interaction design approach for human-automation cooperation

Lack of support for handling a reduction of autonomy in a highly autonomous automation may lead to a stressful situation for a human when forced to take over. We present a design approach, the Reduced Autonomy Workspace, to address this. The starting point is that the human and the automation work together in parallel control processes, but at different levels of autonomy cognitive control, such as setting goals or implementing plans, which is different from levels of automation. When autonomy is reduced, the automation should consult the human by providing information that has been aligned to the level at which the human is working, and the timing of the provision should be adapted to suit the human’s work situation. This is made possible by allowing the automation to monitor the human in a separate process. The combination of these processes, information level alignment and timing of the presentation, are the key characteristics of the Reduced Autonomy Workspace. The Reduced Autonomy Workspace consists of four phases: Identification of the need; evaluation of whether, and, if so, when, and how to present information; perception and response by the human; implementation of a solution by the automation. The timing of the information presentation should be adapted in real-time to provide flexibility, while the level of the information provided should be tuned offline and kept constant to provide predictability. Use of the Reduced Autonomy Workspace can reduce the risk for surprising, stressful hand-over situations, and the need to monitor the automation to avoid them.

Non-Orthogonal Multiple Access-Based Handover for Throughput Enhancement

As non-orthogonal multiple access (NOMA) technology is considered as a new multiple access scheme in cellular networks, a new handover decision algorithm and operational procedure need to be investigated. In this paper, we apply the NOMA technique to handover situations for throughput enhancement in cellular networks. We first derive the condition of <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">NOMA-based handover</i> (NOMA-HO) theoretically to increase the handover user rate while guaranteeing the rate of paired user in the target cell. From this condition, we define a new measurement parameter called <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Interference to Background Interference-plus-Noise Ratio</i> (IBINR) and design a practical NOMA-HO procedure for the measurement of IBINRs and the handover decision. Results show that the proposed NOMA-HO scheme significantly improves cell-edge user throughput compared with the classical OMA-based handover schemes.

Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review

ObjectivesCommunication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to...

A taxonomy of autonomous vehicle handover situations

This paper provides a taxonomy of different forms of autonomous vehicle handover situations. It covers scheduled, emergency and non-emergency handovers and it differentiates between system and driver initiated handovers. The purpose is to examine how the system and driver are responsible for different stages in the transition timeline, i.e., first alert, handover phase, and return to automated control (handback). This is examined from the perspective of SAE levels in comparison to aspects drawn from situational awareness. The work is complemented by analysis drawn from current practice within the insurance industry and interviews with insurers. The result is a closer examination of system and driver responsibility which is independent of but includes SAE levels with respect to specific handover situations. It also identifies gaps between the current legal liability for accidents when compared to aspects such as the situational awareness requirements placed on driver under different driving conditions.

Stereoscopic First Person View System for Drone Navigation

Ground control of unmanned aerial vehicles (UAV) is key to the advancement of this technology for commercial purposes. Not only because handover situations will require humans to take control over the drones when autonomous systems fail. But also, because training deep neural network based control systems require extensive real world data, and capturing meaningful and diverse data is a bottleneck. This axiom is even more prominent for the case of unmanned flying robots where there is no simple solution to capture optimal navigation footage. In such scenarios, improving the ground control and developing better autonomous systems are two sides of the same coin. To improve the ground control experience, and thus the quality of the footage, we propose to upgrade on-boad teleoperation systems to a fully immersive setup that provides operators with a stereoscopic First Person View through a Virtual Reality (VR) Head Mounted Display (HMD). We tested users (n=7) by asking them to fly our drone on the field. Test flights showed that operators flying our system can take off, fly and land successfully while wearing VR headsets. Additionally, we ran two experiments with pre-recorded videos of the flights and walks to a wider set of participants (n=69 and n=20) to compare the proposed technology to the experience provided by current drone FPV solutions that only include monoscopic vision. Our immersive stereoscopic setup enables higher accuracy depth perception, which has clear implications for achieving better teleoperation and unmanned navigation. Our studies show comprehensive data on the impact of motion and simulator sickness in case of stereoscopic setup. We present the device specifications as well as the measures that improve teleoperation experience and reduce induced simulator sickness. Our approach provides higher perception fidelity during flights, which leads to a more precise better teleoperation and ultimately translates into better flight data for training deep UAV control policies.

The non-verbal communication in handover situations are the spice between the lines, to understand the severity of the patient’s condition

Aim : The aim of this study was to investigate emergency nurses’ experiences of verbal handover from emergency medical services and through these experiences uncover patient safety issues in the handover situation. Methods : Design: The design is qualitative inductive and aims to deepen the understanding of the handover situation and to uncover the nurses’ experiences in such a situation. Methods: A qualitative research process which takes its departure in patient safety theory. Nine informants were interviewed and a content analysis was applied. Results : The results show that a lack of structure, lack of seeing the non-verbal communication, the nurses’ own requirement for full control and the lack of active listening involves patient safety risks. Emergency nurses want a handover that is personal and provides a comprehensive picture of the patient to support, deepen or contradict the verbal handover given. Practical implications : The non-verbal communication in the handover situation is key to understand the severity of the situation and give the nurses profane knowledge how to prepare the continuing nursing care. To further support the understanding of the situation, information should be presented in chronological order.

The functions and roles of questioning during nursing handovers in specialty settings: an ethnographic study

Background: Nursing handovers are an important component of patient safety and quality in communicating across transitions of care. Objectives: To determine the functions and roles of questions in nursing handovers, and of how questions contribute to handover quality improvement in specialty settings of an Australian tertiary hospital. Design: An ethnographic research design was employed. Methods: Participant observations were conducted which were audiorecorded and transcribed. Question–response sequences and the roles of questions in the handovers were coded. Results: Questions served many functions, and included: requests for information, requests for confirmation, other initiations of repair, outloud utterances, understanding checks, requests for action and agreement, and knowledge checks. Conclusions: Questioning was mostly used to transmit patient-related information, and nurses could use questioning to jointly construct understandings about patients. Future research should examine how questions function in diverse clinical environments, such as rural and regional hospitals, and how questioning occurs in multidisciplinary handover situations.

Development and validation of a taxonomy of adverse handover events in hospital settings

To develop and validate a taxonomy to classify and support the analysis of adverse events related to patient handovers in hospital settings. A taxonomy was established using descriptions of handover events extracted from incident reports, interviews and root cause analysis reports. The inter-rater reliability and distribution of types of handover failures and causal factors. The taxonomy contains five types of failures and seven types of main causal factors. The taxonomy was validated against 432 adverse handover event descriptions contained in incident reports (stratified random sample from the Danish Patient Safety Database, 200 events) and 47 interviews with staff conducted at a large hospital in the Capital Region (232 events). The most prevalent causes of adverse events are inadequate competence (30 %), inadequate infrastructure (22 %) and busy ward (18 %). Inter-rater reliability (kappa) was 0.76 and 0.87 for reports and interviews, respectively. Communication in clinical contexts has been widely recognized as giving rise to potentially hazardous events, and handover situations are particularly prone to failures of communication or unclear allocation of responsibility. The taxonomy provides a tool for analyzing adverse handover events to identify frequent causes among reported handover failures. In turn, this provides a basis for selecting safety measures including handover protocols and training programmes.

Challenges of Nursing Handover

The aim of this study was to explore the challenges of nursing handover process during shift rotation in hospitals. The research had a descriptive exploratory design with a qualitative content analysis approach. To conduct the study, three pediatric wards were selected at first. Data were gathered through a 4-month observation of nursing handovers by recording the oral conversations of nurses during the process and semistructured interviews. Then, qualitative content analysis was used for data analysis. Two major themes and five subthemes emerged through the data analysis. The first and the second themes were a nonholistic approach and poor management, respectively. In general, applying a holistic approach and managing handover situations are recommended for nursing managers to overcome handover challenges. Future focus could be on addressing handover challenges through an action research study.

Fragmentation of patient safety research: a critical reflection of current human factors approaches to patient handover.

The integration of human factors science in research and interventions aimed at increased patient safety has led to considerable improvements. However, some challenges to patient safety persist and may require human factors experts to critically reflect upon their predominant approaches to research and improvement. This paper is a call to start a discussion of these issues in the area of patient handover. Briefly reviewing recent handover research shows that while these studies have provided valuable insights into the communication practices for a range of handover situations, the predominant research strategy of studying isolated handover episodes replicates the very problem of fragmentation of care that the studies aim to overcome. Thus, there seems to be a need for a patient-centred approach to handover research that aims to investigate the interdependencies of handover episodes during a series of transitions occurring along the care path. Such an approach may contribute to novel insights and help to increase the effectiveness and sustainability of interventions to improve handover.Significance for public healthWhile much of public health research has a preventive focus, health services research is generally concerned with the ways in which care is provided to those requiring treatment. This paper calls for a patient-centred approach to research on patient handover; a significant contributor to adverse events in healthcare. It is argued that this approach has the potential to improve our understanding of handover processes along the continuum of care. Thus, it can provide a scientific foundation for effective improvements in handover that are likely to reduce patient harm and help to maintain patient safety.

A survey of cancer patients’ unmet information and coordination needs in handovers – a cross-sectional study

BackgroundThe care responsibilities for cancer patients are frequently handed over from one healthcare professional to another. These handovers are known to pose a threat to the safety of patients and the efficiency of the healthcare system. Little is known about specific needs of cancer patients in handovers. The objectives of this study were to examine cancer patients’ unmet needs for information and coordination in handovers and to analyse the association between patients’ demographic and clinical characteristics and unmet information and coordination needs.MethodsCancer patients treated in an oncology and a surgery outpatient setting completed a questionnaire developed to examine unmet information and coordination needs of cancer patients in handovers. Associations between unmet needs and comorbidity, treatment type, time since diagnosis, gender, age, and education in various handover situations were analysed.ResultsOf 250 eligible patients 131 participated (response rate of 52%). Overall, 18% of patients had unmet coordination needs and 18% had unmet information needs.Hospital discharge was the type of handover where patients most frequently reported unmet information needs (18%). Unmet coordination needs were most frequently reported in handovers between different hospitals (19%) and in handovers between hospital and general practice (18%). In general, age and education were statistically significantly associated with reporting unmet needs, where patients younger than 60 years and patients with a higher education were more likely to express unmet needs.ConclusionsThe findings indicate room for improvements regarding exchange of information and coordination between healthcare professionals, and between healthcare professionals and patients.

Factors that impact on the safety of patient handovers: An interview study

Improvement of clinical handover is fundamental to meet the challenges of patient safety. The primary aim of this interview study is to explore healthcare professionals' attitudes and experiences with critical episodes in patient handover in order to elucidate factors that impact on handover from ambulance to hospitals and within and between hospitals. The secondary aim is to identify possible solutions to optimise handovers, defined as "situations where the professional responsibility for some or all aspects of a patient's diagnosis, treatment or care is transferred to another person on a temporary or permanent basis". We conducted 47 semi-structured single-person interviews in a large university hospital in the Capital Region in Denmark in 2008 and 2009 to obtain a comprehensive picture of clinicians' perceptions of self-experienced critical episodes in handovers. We included different types of handover processes that take place within several specialties. A total of 23 nurses, three nurse assistants, 13 physicians, five paramedics, two orderlies, and one radiographer from different departments and units were interviewed. We found eight central factors to have an impact on patient safety in handover situations: communication, information, organisation, infrastructure, professionalism, responsibility, team awareness, and culture. The eight factors identified indicate that handovers are complex situations. The organisation did not see patient handover as a critical safety point of hospitalisation, revealing that the safety culture in regard to handover was immature. Work was done in silos and many of the handover barriers were seen to be related to the fact that only few had a full picture of a patient's complete pathway.

Examining communication and team performance during clinical handover in a complex environment: the private sector post‐anaesthetic care unit

Threats to patient safety during clinical handover have been identified as an ongoing problem in health care delivery. In complex handover situations, organisational, cultural, behavioural and environmental factors associated with team performance can affect patient safety by undermining the stability of team functioning and the effectiveness of interprofessional communication. We present a practical framework for promoting systematic, comprehensive measurement of the factors involved in clinical handover. The framework can be used to develop viable solutions to the problems of clinical handover. The framework was devised and used in a recent project examining interprofessional communication and team performance during clinical handover in post-anaesthetic care units. The framework combines five key concepts: clinical governance, clinician engagement, ecological validity, safety culture and team climate, and sustainability. We believe that use of this framework will help overcome the limitations of previous research that has not taken into account the complex and multifaceted influences on clinical handover and interprofessional communication.