Quality Of Handover Research Articles

Wireless Access and Mobility Support for Automated Storage/Retrieval System and Logistics on Aluminum Profile

The preconditions of storage pre-schedule and real-time schedule management are wireless access and mobility support technology in aluminum profile logistic, which is vital for the automated storage/retrieval system(AS/RS) and logistics processes, such as intelligent warehousing and shipment. Understandings characters of the current wireless access technologies, applicability of networking mobility schemes, and their cooperation or compatibility with the Internet of things, decide the AS/RS and logistics structure and its whole efficiency. So the relational technologies and schemes are introduced in this paper from bottom to top according to Open System Interconnect seven layers protocols. It reveals that integration of multi-technologies was widely adopted in project implementation, which can be helpful to achieve high quality of mobile Internet access with lesser costs. Moreover, the feasibility of handover simplification and quality of service construction imply the success of schemes in design. Finally the strategic impact factors of the networking mobility support technology for AS/RS and logistics are concluded as overlapping coverage network optimization, delay tolerant network, and quality of service system based on user behavior.

Team Communication During Patient Handover From the Operating Room

This study was aimed at examining team communication during postoperative handover and its relationship to clinicians' self-ratings of handover quality. Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians' self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.

Can We Make Postoperative Patient Handovers Safer? A Systematic Review of the Literature

Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care from the operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers. Twenty-four included recommendations for structuring the handover process or information transfer. Several recommendations were broadly supported, including (1) standardize processes (e.g., through the use of checklists and protocols); (2) complete urgent clinical tasks before the information transfer; (3) allow only patient-specific discussions during verbal handovers; (4) require that all relevant team members be present; and (5) provide training in team skills and communication. Only 4 of the studies developed an intervention and formally assessed its impact on different process measures. All 4 interventions improved metrics of effectiveness, efficiency, and perceived teamwork. Most of the papers were cross-sectional studies that identified barriers to safe, effective postoperative handovers including the incomplete transfer of information and other communication issues, inconsistent or incomplete teams, absent or inefficient execution of clinical tasks, and poor standardization. An association between poor-quality handovers and adverse events was also demonstrated. More innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes.

Evaluation of the association between quality of handover and length of stay in the post anaesthesia care unit: a pilot study

Evaluation of the association between quality of handover and length of stay in the post anaesthesia care unit: a pilot study

Safer ICU trainee handover: a service improvement project

Quality handover between team members within the ICU is vital for patient safety. Critically ill patients are at high risk of medical errors; these complex patients are exposed to high-risk interventions, medical and procedural [1]. Distractions are known to be particularly prevalent within critical care [2]. This can compromise handover efficiency, interrupt information-giving and may ultimately lead to poorer patient outcomes [3]. We sought to demonstrate the capability of junior physicians to lead change to their practices that benefit the quality of patient care in a large critical care unit. We present an improvement project that has transformed handover quality in our ICU.

Impact of a structured template and staff training on compliance and quality of clinical handover

IntroductionChange in junior doctors working pattern has brought effective and safe clinical handover into a central role to ensure the patient safety and high quality care. We investigated whether the compliance and quality of clinical handover could be improved through the use of a standardised and structured handover template. MethodsA computerised template was developed in accordance with handover guidelines provided by the Royal College of Surgeons of England. Pre- and post-intervention audits against an eleven-point dataset pertaining to the handover of acute surgical admissions were undertaken. The results from the two discrete audits periods were compared to examine the impact of intervention. ResultsThere were 137 acute surgical admissions during pre-intervention and 155 admissions in post-intervention audit period. A significant improvement in overall handover practice was observed in post-intervention period. The documentation of patient hospital number (84 (61%) vs. 132 (85%) p < 0.001), past medical history (39 (28%) vs. 75 (48%) p < 0.001) and patient assessment by a senior member of the on-call team (3 (2%) vs. 125 (85%) p < 0.001) all demonstrated significant improvements upon use of structured template. Compliance to effective handover improved following increased awareness of the importance of safe clinical handover among the junior doctors. ConclusionImplementation of a standardised guideline-based structured handover template and training of junior doctors are likely to improve compliance to agreed standards, promote quality of care, and protect patient safety.

An observational study of teamwork skills in shift handover

BackgroundClinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven. This study aimed to assess the feasibility of measurement of teamwork skills in shift handover and the applicability of adapted teamwork skills rating scales to a shift handover environment. MethodsMorning surgical shift handovers were assessed for completeness of information transfer, duration, interruptions and handover attendance. Handover teamwork skills were evaluated using two validated rating scales, adapted from one-to-one handovers and intra-operative teamwork skill measurement. Results50 handovers, including 306 patients were observed. Communication checklist completion was 97% but the quality of teamwork skills varied widely between handovers. There was very good concurrent validity between the two teamwork skill rating scales (Spearman's rho = 0.67, p < 0.001). There was no significant correlation between content completion, duration, interruptions or attendance and teamwork skill ratings. ConclusionsTeamwork skills vary widely between handovers and can be consistently scored using both rating scales. It is feasible to use adapted teamwork skill rating scales in shift handover and they appear to measure different constructs to traditional handover measures such as interruptions and communication checklist completion. The assessment of teamwork skills is a necessary complement to the assessment of completeness of information transfer when evaluating the overall quality of handover.

Handover process: how to improve quality and safety through an ergonomic solution

Patient safety practices for enhancing the quality and safety of handover are context sensitive interventions. In this article we explore the use of cultural probes as a qualitative technique with a twofold objective: eliciting implicit activity pattern and tools that may constitute resources for the design of effective handover solutions and prompting health care practitioners' participation and involvement.

Editorial

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning. Maintaining patient safety is a mantra which will be familiar to acute physicians, particularly those who attended any of the recent SAM meetings, where this theme has been well rehearsed. An acute medical unit can provide significant safety benefits by concentrating resources in a single area. However, for the 60% who cannot go directly home from the AMU, this model creates the need for care to be transferred at some point. It is well recognised that transfer is a time at which patient safety can become compromised; so if safety is our mantra, acute physicians and nurses have a responsibility to manage this process effectively. The article by David Hindmash and Liz Lees provides an important addition to the limited literature in this area. Structured checklists are becoming an increasing part of medical practice; this paper highlights how a checklist can be used to improve the quality of handover from AMU. The authors emphasise the need to keep the form simple, and the importance of regular reinforcement to ensure that it is used. What skills and attributes does an acute physician require? With interview season approaching it’s a question that many prospective trainees will be contemplating – remaining calm under pressure, communication skills and teamworking are some of the standard responses; but what about a good sense of smell? Most of us recognise the characteristic odour of melaena , or the whiff of infected urine. But the absence of body odour might be equally revealing. Luther and Yap noted their patient to be ‘remarkably clean’ – unusual, perhaps, for a young male patient on the AMU; along with his persistent demands to use the showering facilities, this was a clue to the final diagnosis of Cannabis Hyperemesis Syndrome.It’s a case worth reading and highlights the importance of lateral thinking, particularly when patients repeatedly attend – as well as having a ‘good nose’ to sniff out something unusual!

Clinical handover of patients arriving by ambulance to a hospital emergency department: A qualitative study

The aims of this study were to (1) explore the clinical handover processes between ambulance and ED personnel of patients arriving by ambulance at one hospital and (2) identify factors that impact on the information transfer to ascertain strategies for improvement. A focused ethnographic approach was used that included participant observation, conversational interviews and examination of handover tools. Participants included ambulance paramedics, nurses and medical practitioners from an ambulance service and regional hospital located in South East Queensland, Australia. Grounded theory methods of constant comparative data analyses were used to generate categories of findings. Two types of clinical handover were identified: (1) for non-critical patients and (2) for critical patients. Quality of handover appears to be dependent on the personnel's expectations, prior experience, workload and working relationships. Lack of active listening and access to written information were identified issues. Clinical handover between two organisations with different cultures and backgrounds may be improved through shared training programmes involving the use of guidelines, tools such as a whiteboard and a structured communication model such as MIST. Future participatory research to evaluate new handover strategies is recommended.

Abstract P150: Cardiac Cath Lab Handovers for Inpatients

Background: Patient handovers between clinical areas are a crucial period in clinical care. Poor communication between caregivers can increase the risk of adverse events. We identified gaps in the quality of patient handovers between the cardiac catheterization laboratory (cath lab) and inpatient units. We initiated a process redesign of handovers for hospital patients pre-procedure and post-procedure from the cath lab. Aim: To improve communication and patient safety by creating a standardized handover tool of appropriate detail for each segment (pre- and post-procedure), and to emphasize interactive person-to-person communication between staff of the cath lab and inpatient units. Methods: We engaged staff from each area to identify handover strengths and weaknesses with the existing process. A baseline audit of handover elements for each segment was performed by the hospital quality management office. A standardized handover tool with specific data elements was created for each segment. Phone handovers could be used in the pre-procedure segment, but the goal was for post-procedure handovers to be face-to-face. Rapid cycle process improvement was used to refine the handover process and tool. After piloting the new process, a follow up audit of handover data elements was performed. With successful piloting of the new process, a second phase was added to improve handovers by ensuring completion of post-procedure orders before the patient was returned to their inpatient unit. Results: There was improvement in completion of all elements from baseline to pilot phase post-implementation in both handover segments (Table). In the second phase, completion of post-procedure orders prior to patient return to the inpatient unit went from zero percent to 85 percent compliance. Conclusion: Collaboration of staff and development of a standardized handover process between the cath lab and inpatient led to major improvements in performance. Cath Lab Handover Baseline to Pilot Improvements Overall Quality 3.76 4.05 0.13 Pre and Post Cath Handover Elements Baseline Pilot Improvement Abnormal Lab Values 0.25 1.00 0.75 H&amp;P Complete 0.60 1.00 0.40 DNR Status 0.50 0.90 0.40 Consent Complete 0.29 0.64 0.35 Isolation Status 0.50 0.67 0.17 Dye Administration 0.25 1.00 0.75 Pulse Assessment 0.73 0.94 0.21 Post Procedure Ambulation Time 0.64 0.82 0.18

Patients' perceptions of safety and quality of maternity clinical handover

BackgroundMaternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care.MethodsThis paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA.ResultsAlmost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour.ConclusionsThis study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication.Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective.Future research involving patients and their support people in supporting and evaluating handover should be considered.

Quality of handover of patients to the postanaesthetic care unit staff

Quality of handover of patients to the postanaesthetic care unit staff

Handover after pediatric heart surgery: A simple tool improves information exchange*

To improve the quality of handover of complex patients after pediatric cardiac surgery through the use of a simple handover tool. Prospective, pre-/postinterventional. A tertiary care, pediatric intensive care unit in North America. Thirty-three consenting healthcare providers from pediatric cardiac anesthesia, critical care, and cardiothoracic surgery participating in 31 handovers. A fill-in-the-blank, one-page tool was developed to guide the information transmitted by the surgeon and anesthesiologist to the pediatric intensive care unit team during handover of postcardiac surgery patients. Total handover score, four subscores, handover duration, and postoperative high-risk events were measured before and after introducing the tool into clinical practice. The patients in both the pre- and postintervention groups were similar at baseline. The total handover score (maximum 43 points) improved significantly after the implementation of the handover tool (28.2 of 43 ± 4.6 points vs. 33.5 of 43 ± 3.7 points, p = .002). There was also a significant improvement in the medical (8.3 ± 2.6 vs. 10.3 ± 2.1 points, p = .024) and surgical (7.5 ± 1.4 vs. 9.3 ± 1.6 points, p = .002) intraoperative information subscores. Use of the tool did not prolong handover duration (8.3 ± 4.6 vs. 11.1 ± 3.9 mins, p = .1). There was a trend toward more patients being free from high-risk events in the postintervention group (31.2% vs. 6.7%), but this did not reach statistical significance (p = .1). Use of a simple tool during handover of pediatric postcardiac surgery patients resulted in a more complete exchange of critical information with no significant prolongation of the handover duration.

019 Improving the quality of ambulance crew hand-overs: a qualitive study of knowledge transfer in emergency care teams

IntroductionAmbulance crews make 3.6 million emergency journeys each year. Effective patient transfer relies on verbal, non-verbal and documentary handover of complex information in time-limited environments. Weaknesses in ambulance handover have...

Analysis of adherence to published guidelines for vestibular schwannoma screening: Correlating published guidelines to diagnostic yield

Analysis of adherence to published guidelines for vestibular schwannoma screening: Correlating published guidelines to diagnostic yield

The ABCD of handover: A simple system to improve the quality of surgical handover

The ABCD of handover: A simple system to improve the quality of surgical handover

Emergency physician intershift handover - can a dINAMO checklist speed it up and improve quality?

Physician intershift handover has been identified as an area of high risk for adverse events, representing a critical step in patient care transition. Due to frequent shift changes and high patient numbers, emergency departments offer an ideal study setting. At a tertiary care hospital emergency department we aimed to reduce the time needed for patient handover while maintaining or improving quality of information passed between shifts. Between 31 March and 20 June 2008 we observed intershift handovers in all non-surgical patients at 8 a.m. between nightshift and dayshift. We collected data on handover characteristics and patient demographics. After the usual clinical rounds following each handover, we asked senior physicians about missing or wrong information and possible implications for patient management. From 31 March to 9 May pre-interventional observation took place. On 13 May the dINAMO checklist with five items and a standardised feedback following each handover was introduced. Post-interventional observation lasted until 20 June. 61 handovers totalling 23.4 hours of observation time covered 1011 patients. The intervention using the dINAMO checklist reduced mean handover time by 26% from 99 ± 3.3 to 73 ± 2.8 seconds per individual patient (p <0.0001). This resulted in a reduction of morning handover duration from 30 to 20 minutes. Senior physicians reported insignificant improvement of quality of handover. A significant decline in missing or wrong information from 194 incidents in 496 patients to 78 in 470 patients was recorded. An intervention consisting of a simple checklist of five items (dINAMO) and an immediate feedback on quality not only contributes to a significant shortening of time needed for physician intershift handover in a university hospital emergency department, but simultaneously helps to improve quality of information and therefore patient management.

Improving actual handover behavior with a simulation-based training intervention

A simulation-based training intervention to improve patient handovers between anesthesia providers (APs) and Post-Anesthesia Care Unit (PACU) nurses (RNs) in adult (VUH) and pediatric (VCH) PACUs, was developed, implemented, and evaluated. The intervention included didactic webinars, an electronic handover report tool, a 2-hour simulation-based training session and a 1-hr “refresher” course several months later. Training focused on interpersonal skills and overcoming obstacles to effective handovers. Trained nurses observed and evaluated 981 actual PACU handovers over 12 months using a standardized rating tool. A different blinded observer scored pre- and post-training simulated handovers. A culture survey was administered before and after the intervention. After training, handover quality improved significantly with more than 70% of handovers rated as “effective” in both PACUs (P&lt;0.001). The training status of the handover giver (AP) was the critical determinant of handover effectiveness. Following full implementation, new (untrained) clinicians performed effective handovers suggesting culture change and/or implicit training.

Socio-technical challenges in implementing safe patient handovers.

Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. Drawing on three ethnographic case studies we identify and discuss socio-technical issues which must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover and data standards and system integration warrant ongoing research in socio-technical aspects of care handovers.