Handover System Research Articles

Improving the Accuracy of the Gynaecology Handover Process: An Effective Quality Improvement Project at a University Hospital in the United Kingdom.

Objectives The objective of this study was to introduce a new system of handover in the gynaecology department and ensure its effectiveness with dynamic improvement measures. This was launched as a quality improvement project in a district general hospital in the United Kingdom. The primary aim was to start and consolidate a new system of a separate gynaecology handover in the presence of consultants, registrars (incoming and outgoing), senior house officers (incoming and outgoing) and gynaecology nurses. Design The strategy for consolidation included a daily quality review on the basis of a fixed proforma, identifying the obstacles faced, and improvising dynamic solutions. A new quality check proforma was introduced which took into account: (i) Presence of team members, (ii) Following of proper SBAR (Situation, Background, Assessment, Recommendation) format in the handover, (iii) Updating of patients awaiting surgeries with every detail on the list, (iv) Proper handing over of pending referrals, (v) Mention of sick patients with proper importance, and (vi) Proper handing over of new admissions. A pilot study was done to evaluate the baseline performance of the unit regarding the gynaecology team handover on the basis of the same proforma. The result of the baseline study was noted as the reference. Each day the team receiving the handover was interviewed for the next five months about the quality of each of the parameters on the predesigned proforma and the responses were noted. The answers were designed in binary form (Yes/No). These results were compiled at the end of each month. The result from each individual month was reviewed and the problems were identified and practical solutions were applied. These changes were noted and plotted graphically as a bar diagram. The monthly audit results were tabulated in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States). Results Pilot study results and final month results were compared with the help of the Mcnemar test and statistically significant improvement was noticed in seven out of eleven parameters. There was a steady and gradual improvement in the responses. The possible limitations of the study were also noted at the same time. Conclusion The quality improvement project was highly effective in improving the quality of handover and increased patient safety to a large extent.

Integrated nursing handover system and it’s implication to job performance

Integrated nursing handover system and it’s implication to job performance

Implementing a Digital Handover System to Improve Safety and Efficacy of Handover Across Acute Psychiatric Inpatient Sites

Implementing a Digital Handover System to Improve Safety and Efficacy of Handover Across Acute Psychiatric Inpatient Sites

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Improving availability and accuracy of the junior doctors’ on-call handover through digitalisation

Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables...

Probabilistic Motion Prediction and Skill Learning for Human-to-Cobot Dual-Arm Handover Control.

In this article, we focus on human-to-cobot dual-arm handover operations for large box-type objects. The efficiency of handover operations should be ensured and the naturalness as if the handover is going on between two humans. First of all, we study the human-human dual-arm large box-type object natural handover process to guide this research. Then, for efficiency, we combine the probabilistic approach with the online learning algorithm to predict the beginning of the handover task and handover positions. The online updating probabilistic models can deal with not only human givers' regular motion patterns but also their irregular motion patterns. Then, to guarantee that human givers can perform handover operations naturally, we apply the probabilistic robot skill learning method kernelized movement primitives (KMPs) to adapt the learned receiving skills and fulfill some constraints for safety based on online predicted results. Furthermore, we give special attention to the dual-arm grasp strategy and control design to guarantee a stable grasp. In addition, we equip this handover system on a Baxter cobot and extend its grippers to make it more suitable for dual-arm handover operations. The experimental results show that the proposed handover system can solve human-to-cobot dual-arm handover operations for large box-type objects naturally and efficiently.

Long-Term Sustainability and Adaptation of I-PASS Handovers.

Inadequate communication during transitions of care is a major health care quality and safety vulnerability. In 2013 Massachusetts General Hospital (MGH) embarked on a comprehensive training program using a standardized handover system (I-PASS) that had been shown to reduce adverse events by 30% even when not completely executed on each patient. In this cross-sectional study, the authors sought to characterize handover practices six years later. Using a standardized interview tool, the researchers evaluated handovers between responding clinicians in 10 departments and then validated these findings through direct observations, allowing for flexibility and customization in the I-PASS elements. The study qualitatively compared I-PASS element use in verbal handovers to MGH early postintervention data, as well as verbal and written handovers with the I-PASS Study Group's postintervention results. The authors observed 156 verbal and reviewed 182 written patient handovers. Ninety percent of departments adhered at least partially to the I-PASS system. Average handover duration ranged from 0.6 to 2.1 minutes per established patient. The service with best I-PASS adherence also consistently included the most information per unit of time. Acknowledging substantial differences in study technique, MGH adherence was, on average, comparable or better on all I-PASS elements in verbal handovers and on three of four elements of written handovers compared with the I-PASS Study Group's postintervention results. Although uptake has varied across services, six years after hospitalwide implementation of I-PASS, the majority of services are performing structured and sequenced handovers, most of which include some elements of the I-PASS system. Those services with the best I-PASS adherence conducted the most efficient handovers.

Learning Human-to-Robot Dexterous Handovers for Anthropomorphic Hand

Human-robot interaction plays an important role in robots serving human production and life. Object handover between humans and robotics is one of the fundamental problems of human-robot interaction. The majority of current work uses parallel-jaw grippers as the end-effector device, which limits the ability of the robot to grab miscellaneous objects from human and manipulate them subsequently. In this paper, we present a framework for human-to-robot dexterous handover using an anthropomorphic hand. The framework takes images captured by two cameras to complete handover scene understanding, grasp configurations prediction, and handover execution. To enable the robot to generalize to diverse delivered objects with miscellaneous shapes and sizes, we propose an anthropomorphic hand grasp network (AHG-Net), an end-to-end network that takes the single-view point clouds of the object as input and predicts the suitable anthropomorphic hand configurations with 5 different grasp taxonomies. To train our model, we build a large-scale dataset with 1M hand grasp annotations from 5K single-view point clouds of 200 objects. We implement a handover system using a UR5 robot arm and HIT-DLR II anthropomorphic robot hand based on our presented framework, which can not only adapt to different human givers but generalize to diverse novel objects with various shapes and sizes. The generalizability, reliability, and robustness of our method are demonstrated on 15 different novel objects with arbitrary handover poses from frontal and lateral positions, a system ablation study, a grasp planner comparison, and a user study on 6 participants delivering 15 objects from two benchmark sets.

FTP4.3 Improving awareness of total parenteral nutrition administration in general surgical patients: a tertiary care hospital experience

Abstract Introduction Dieticians on the general surgical ward are valuable in providing recommendations to optimise patient nutrition, including the administration of total parenteral nutrition (TPN). Prescribing TPN is time-intensive as patients' clinical status and biochemical profile are assessed to avoid re-feeding syndrome. This needs adjustment of the dieticians’ recommendations, highlighting the importance of clinician awareness of patients recommended for TPN. Methods We carried out a quality improvement project (QIP) on the general surgical ward of a tertiary centre teaching hospital which involved two plan-do-study-act (PDSA) cycles. We used primary and secondary qualitative surveys to collect data. In the first cycle, we implemented a daily whiteboard handover system in the doctors’ office which displayed the patients recommended for TPN. In the second cycle, we added a TPN recommendation section to the daily patient handover / ward patient list. Results Pre-intervention respondents reported lack in awareness of patients recommended for TPN, and felt prescription was often delayed. Use of a whiteboard was well accepted by junior doctors as well as dieticians and improved awareness of patients on TPN. However, this duplicated the workload and information sources for dieticians and doctors. Use of the patient handover list resulted further improved awareness and subsequently quicker timeliness of TPN prescribing. Conclusions Both whiteboard displays & highlighting the potential TPN patients in the handover lists were well-accepted and effective ways to improve awareness of patients on TPN. Sustainable interventions should not result in duplication of workload or information. Future work could include quantitative analysis of the above interventions.

Evaluation of a Standard Handover Tool at a Pediatric Tertiary Care Unit in Oman.

Background The handover system is a great communication tool physicians use to transfer and receive patients' care-related information. The introduction of structured handover tools has resulted in a dramatic reduction in hospital-acquired injuries. We hypothesize that the I-PASS handover tool will improve both written and verbal communication without compromising the handover duration. The current study aims to improve the quality of care and patient safety by evaluating the applicability of I-PASS handover in the Child Health Department at Sultan Qaboos University Hospital, Oman. Results A total of 20 trainees were enrolled in this study.After the implementation of I-PASS, 70% (14/20) of the respondents thought that the handover was well-structured, compared to 30% (6/20) prior to the implementation of I-PASS (P = .003). Due to I-PASS, about 80% of the participants could identify deteriorating patients and around 60% were confident in addressing emergencies. The I-PASS handover technique has raised participants' satisfaction from 80% to 95%. Before I-PASS, the mean adherence rate across all 10 variables was 28.7/50 (57.4%), compared to the post-I-PASS rate of 47/50 (94%). Conclusion The I-PASS system is a feasible and flexible clinical handover tool. This study showed that I-PASS has improved on-call handovers and patient safety.

Evaluating Psychometric Properties of the Sultan Bin Abdulaziz Humanitarian City (SBAHC) Nurses' Electronic Handover Tool.

Handover is crucial during the transfer of patient care between healthcare professionals.Successful handover maintains patients' safety and high-quality care. The electronic handover of patients' information is achievable, feasible, and potentially improves the quality of patient care. However, the introduction of the electronic handover is relatively recent and challenging for healthcare providers, especially nurses. Since Sultan Bin Abdulaziz Humanitarian City (SBAHC)has recently implemented an electronic handover system among nurses, the main aim of the current study was to develop a tool to assess the perception and barriers to electronic handover systems among nurses working at SBAHC and evaluate its psychometric properties. The tool content and face validity were assessed by the content validity ratio (CVR). Exploratory and confirmatory factor analysis were used as validity methods, while the test-retest and inter-item consistency were used as reliability measures. The sample size was planned as five times the number of questions and a total of 200 nurses participated in the study. The criteria required for factor analysis were met as indicated by the results of the Kaiser-Mayer-Olkin test and Bartlett's test of sphericity. The reliability results showed a Cronbach's alpha coefficient ranging from 0.858 to 0.910 for the perception subscale and from 0.564 to 0.789 for the barrier subscale, and an overall interclass correlation of 0.986, p<0.001. The developed SBAHC electronic handover tool was valid and reliable, and it is advisable to consider it at the initial stages of implanting an electronic handover system to identify obstacles that are faced by the staff to be considered and addressed by the higher management.

SSHS: SDN seamless handover system among LAN access points

SummaryIn recent years, artificial intelligence techniques, such as software‐defined networks (SDNs), machine learning classification (ML classification), and mobility models (MMs), have become vital in developing networks. Furthermore, communication methodologies, such as handover, directly affect network performance. In this paper, we propose a new system named SSHS, SDN Seamless Handover System, that combines SDN with an ML classifier to administer the network connection of mobile nodes. Through the SSHS system, the SDN will centralize the control to enable comprehensive management over the network, coupled with a decision tree (DT) classifier in the RYU controller to bring intelligence to the SDN application by enabling data analysis and prediction among mobile nodes generated by the RSSGM model. We present the SSHS model's effectiveness in providing a seamless communication handover among multiple access points (APs). The results of this study revealed that the SSHS provided a seamless handover among APs by improving the throughput by 26%, and decreasing the delay of arriving packets by 73% to standard SDN handover system.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study

BackgroundThe unprecedented increase in the nurses’ workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU.MethodThis is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA).ResultsThe results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001).ConclusionThe use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

Efficient VANET handover scheme using SSDN by incorporating media independent handover framework

A handover mechanism in a vehicular network can link a mobile vehicle to the Internet. Nonetheless, Vehicular Ad hoc Networks (VANETs) have a tendency to change their network topology frequently because of the mobility of vehicles. Since there will be many handovers, network performance will be negatively affected. A new architecture called Software Defined Network (SDN) can be used to make the vehicular network more efficient by making network devices that connect to each other programmable. This research proposes a seamless handover system in which the Software-Defined Networking (SDN) and Media-Independent-Handover (MIH) Framework are used to implement dynamic topology changes in VANETs. VANET as well as Internet of Things (IoT) plays a good role on the handover scheme. IoT gives a better results in the traffic management, security and connectivity. In order to demonstrate the dominance of our proposed model, network simulations are carried out from a variety of angles and perspectives. The results reveal that when a handover occurs, our solution can greatly enhance network performance. The performance can be evaluated in the form handover delay, handover failure ratio, throughput and packet loss with 5%, 40%, 10% and 2% improved with the existing methods.

Multi-Level Fuzzy Inference System Based Handover Decision Model for Unmanned Vehicles

In coming years, mobile communications systems will have a significant role for Unmanned Aerial Vehicles (UAVs), that will either function as mobile users or as mobile base stations in the sky. No doubt UAVs or drones provide a number of benefits for mobile communications networks and other non-communication services, but they also have a number of drawbacks, particularly when it comes to managing handover (HO). A number of approaches have already been suggested by various authors for making the HO easy and efficient, but only few parameters were considered for making the HO decision. However, with the advancement in technology and continuous rise in users, the handover system's reliance factors continue to grow, which could make the system more complex. As a result, the requirement for creating and implementing a system that can effectively manage system complexity arises. In order to reduce the complexity of the system, a novel method is proposed in this paper in which multi-level fuzzy system is used. The main goal of using the fuzzy system at different levels is to minimize the rule complexity of fuzzy systems at different levels which in turn enhances the performance of handover systems. In addition to this, number of parameters like coverage, speed limit, cost, connection time, security and power consumption were taken into consideration while designing the handover system. The model works in three levels, at the first level coverage, speed limit and cost parameters are processed to generate the first probability output. At the second level, connection time, security and power consumption parameters are considered to get the second probability output. The two outputs obtained thus serves as the input to third level where again they are processed to get the final output as estimation level. The efficacy of the suggested multi-level fuzzy system is analyzed in the MATLAB tool. The experimental results are obtained and compared with the traditional handover systems in terms of various dependency factors to prove its efficiency.

Fuzzy Logic Based Handover Authentication in 5g Telecommunication Heterogeneous Networks

Under various deployment circumstances, fifth-generation (5G) telecommunications delivers improved network compound management with fast communication channels. Due to the introduction of the Internet of Things (IoT) in data management, the majority of the ultra-dense network models in 5G networks frequently have decreased spectral efficiency, weak handover management, and vulnerabilities. The majority of traditional handover authentication models are seriously threatened, making them vulnerable to a variety of security attacks. The authentication of networked devices is the most important issue. Therefore, a model that incorporates the handover mechanism and authentication model must be created. This article uses a fuzzy logic model to create a handover and key management system that focuses on cloud handover management and authentication performance. In order to decrease delays in 5G networks, the fuzzy logic is built with multiple criteria that aim to reduce the number of executed handovers and target cell selection. The simulation is run to evaluate the model’s performance in terms of latency, spatial complexity, and other metrics related to authentication attack validation.

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.

Requirements for an electronic handover system for interprofessional collaboration between psychotherapists and occupational health professionals – a qualitative study

BackgroundAn electronic handover system provides a potential way to bridge the interface between psychotherapy and occupational health. This qualitative study therefore aimed assessing (1) content-related and (2) functional requirements that psychotherapists and occupational health professionals expect from an electronic handover system to exchange relevant information about their patients with common mental disorders.MethodsFive focus groups with psychotherapists and occupational health professionals (occupational physicians and members of company integration management) were conducted via video conference using an interview guide. The focus groups were transcribed and content-analysed using MAXQDA.ResultsWith regard to content-related requirements, information that serve to assess employee’s ability to work was described as particularly relevant by occupational physicians and members of company integration management (e.g. restrictions in certain work areas or ability to work under time pressure). Psychotherapists indicated that information about the employee’s working conditions is particularly relevant. This includes description of work tasks or conflicts at the workplace. Concerning functional requirements, all professional groups attached importance to data security and functions to improve communication and collaboration (e.g. the use of standardised handover forms).ConclusionThis study provides insight into the desired content-related and functional requirements by psychotherapists, occupational physicians and members of company integration management for an electronic handover system. However, the theoretical and practical development of such a system requires several additional steps, such as the involvement of further relevant stakeholders (e.g. patients, software developers).

WE3.13 Friday Handover Flow

Abstract Aims Handover between teams is a requirement between colleagues to ensure patient safety. An electronic weekend handover Friday noon with the whole surgical team was implemented in 2017. This is the second cycle to close the loop. Methods The implementation of ‘Careflow’ software had all been initiated in 2017 to modernise handover from paper to e-handover. Anonymised questionnaires were sent to all surgical doctors 6 months following the initial intervention. An additional intervention of a Friday afternoon handover prior to the weekend was started following this. For the second cycle a similar questionnaire was distributed to observe whether the changes have been sustained and the impacts beneficial. Results From the first cycle 97% felt e-handover was better than paper handover. Comparing first and second cycles; 97% vs 80% reported adequate handover time, 97% vs 57.1reported handover incorporated into the working day, 42% vs 97.2% reported handover usually consultant led, 41% vs 48.6% were aware of RCS handover guidelines 81% vs 85.7% reported ‘Caredlow’ as having a positive impact. Overall 91.1% of staff were more than 60% satisfied with Friday midday weekend handover, and 100% wanted the practice to continue. Conclusions A prioritised handover, dedicated room, adequate time and senior presence are all required for an effective handover. To modernise and improve continuity of care, an electronic handover system is a positive, effective tool. In addition a Friday noon handover prior to the weekend enables the modern NHS to provide the best and safest practice for our patients.

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.