Quality Of Handover Research Articles

Trust-wide improvement and standardisation of the medical handover

AimsPrimary: To improve the quality of medical handover by increasing trust-wide completion rate for agreed quality standards from baseline to 80% by July 2019To standardise the medical handover across all 5 boroughs within the trust by July 2019Secondary: To separately assess the completion rate for new patient checks in relation to baselineBackgroundNot only is there a recognised variation in the medical handover across Pennine care foundation trust's (PCFT) 5 boroughs (Tameside, Rochdale, Bury, Oldham and Stockport), but there also appears to be diminished adherence to quality standards to a varying extent. This was shown to result from a combination of human factors and process errors consequently leading to near-miss clinical incidents. This project was therefore designed to highlight and address these issues in order to promote patient safety.MethodHaving identified the problems and agreed on quality standards, baseline data were gathered through May 2019 with the primary outcome measure being the percentage completion rate for quality standards across all handovers. Changes were made to the handover document in June 2019 followed by introduction of a new handover document and post-intervention data collection through July 2019. Doctors’ satisfaction with the new handover document using a typical 5-level Likert scale was measured using a trust-wide online survey.ResultOur results showed a considerable Trust-wide improvement in the completion rate for agreed quality standards from 54% at pre-intervention to 77% at post-intervention with all 5 boroughs demonstrating improvement to varying extents. This is noted to be reasonably close to the project aim of improving the completion rate from baseline to 80%. With regards to new patient checks, there was a marginal Trust-wide increase in completion rate from 53% at pre-intervention to 56% at post-intervention. Additionally, the trust-wide online survey measuring doctors’ satisfaction with the new handover revealed a majority (82%), either strongly agreed (27.3%), or agreed (54.6%), that the new handover document has improved the overall quality of handovers.ConclusionTrust-wide standardisation of the handover has now presented the opportunity to benchmark boroughs within PCFT against one another in terms of adherence to quality standards and alignment with best practice relating to patient safety. While substantial improvement may have been made in the overall quality of handovers across the trust, the inter-borough disparity in the extent of improvement identified gaps for future follow-up or related projects.

The quality of handover on an inpatient psychiatric unit - information is key!

AimsTo study the quality of handover, between nursing staff and doctors, on an inpatient psychiatric unit.Effective handover between professionals is vital to ensure the accurate transfer of useful information to enable quality care and patient safety.Implementation of a handover tool has been shown to improve patient safety, especially when used to structure communication over the phone.Feedback at trainee doctor forums highlighted insufficient handover from nursing staff whilst on-call, a problem which prompted further exploration.MethodStandards were developed for the expected quality of handover, consisting of a set of criteria for the minimum information required to ensure a safe and effective handover, stemming from the SBAR (Situation, Background, Assessment, Recommendation) approach, with adequate identification of patients, clear communication of the current situation and relevant details.In an inpatient psychiatric setting, telephone calls to the on-call doctor were recorded for a two-week period, documenting whether key information was communicated.ResultTotal number of calls to on-call doctor recorded: 68. The patients name was given in 49% and the ID number in just 10%. Both relevant diagnosis/history and NEWS score was provided in 18%. However, the current issue and recommendation was given in 90% and 95% respectively.ConclusionThe results thus far demonstrate a lack of structure and often limited information delivered in handover from nursing staff to the on-call doctor. This leads to difficulties in prioritisation, identifying the urgency of the situation and inefficiencies, as time is spent requesting further information which is not readily available.After nursing colleagues were made aware, results from a further two-week period, from 65 total calls, demonstrated some improvement. Patient name given in 51%, ID number in 18%, relevant diagnosis/history in 12%, NEWS score in 17%, current issue in 92% and recommendation in 51%. It is clear that with marginal improvement, there remains a problem which we aim to address by collaborating further with senior nursing leads whilst implementing a succinct handover proforma. It is likely that with COVID-19 as the priority on the agenda this past year, quality improvement projects such as this has not been the main focus. We hope that we will be able to implement these changes in the coming months.

512 Trauma Meetings in the Time of COVID

Trauma & Orthopaedics (T&O) has taken a backseat during COVID-19. As the focus has shifted to care of COVID patients, other specialties have adjusted their daily working. At our local hospital, the dedicated Orthopaedic ward was absorbed into the Intensive Care department, necessitating migration to a smaller, shared working space. This project looked at ways of increasing clinical efficiency, patient safety and education within the T&O department.Members of the T&O department at The Princess Alexandra Hospital were invited to attend daily trauma meetings virtually via Microsoft Teams. In addition, the impact of moving to a larger, dedicated meeting space was assessed. Pre- and post-intervention questionnaires were delivered to assess response.Post-intervention questionnaires revealed a significant improvement in the perception of ability to see XRs (p < 0.001), quality of handover (p = 0.018), ability to discuss and formulate management plans (p = 0.002), social distancing (p < 0.001), location (p = 0.002) and trauma meetings overall (p < 0.000). The educational value of trauma meetings did not improve as anticipated, however.Virtual Trauma Meetings are a useful adjunct, allowing clinicians safely contribute to clinical care. In addition, the location of daily trauma meetings is an important factor to consider, both for the safety of patients and for the safety of clinicians.

485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project

Abstract Introduction The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients. Method Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation. Results The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration. Re-audit demonstrated significant improvements in all domains to &amp;gt; 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document. Conclusions A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.

Nurses’ critical thinking and clinical decision-making abilities are correlated with the quality of nursing handover

Critical thinking skills are instrumental for nurses to address patients complex situations and needs to ensure continuity of care. It's aimed to identify the relationship between nurses critical thinking and clinical decision-making abilities with the quality of nursing handover. A cross-sectional, descriptive correlational study was conducted with 205 nurses. Simple random sampling was used for participant recruitment. Data were collected by a questionnaire analyzed using Pearson's correlation test. In this study, nurses had good critical thinking, clinical decision-making abilities and handover quality. There is a strong relationship between critical thinking and clinical decision-making and the quality of nursing handover (p=0.001; r=0.384; r=0.247). This study confirms the relationships of nurses critical thinking and clinical decision-making abilities with the quality of nursing handover. Education level appears to have the largest influence, the results imply a need for nurses to have higher education.

Impact of a blended curriculum on nursing handover quality: a quality improvement project

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is,...

Exploring postoperative handover quality in relation to patient condition: A mixed methods study.

To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. Observational mixed methods convergent design. Postoperative patient handovers were observed collecting quantitative (n=109) and qualitative data (n=48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n=14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

Literature Review: Peran Kepemimpinan Transformasional dalam Meningkatkan Persepsi Perawat terhadap Handover

Nurses' perceptions of the implementation of handovers is various. The wrong perception of the implementation of handovers can affect the communication process that threatens patient satisfaction and safety. The head of space as a transformational leader has an important role in influencing nurses' perceptions in the implementation of handovers. The method used in this paper is study literature from several journal articles. The author analyses and synthesizes to describe the role of transformational leadership in increasing nurses' perceptions of the implementation of the handover from the literature study that has been done, the four elements of transformational leadership have a positive role in influencing factors affecting nurses' perceptions. The more positive the impact of transformational leadership on perception factors, the more will have a positive impact on nurses' perceptions. Through the application of transformational leadership, nurses' perceptions and the quality of handovers can improve. It can be concluded that transformational leadership has a positive role in increasing the perception of nurses. This transformational leadership style can be used as a solution and is highly recommended for use by managers / heads of space as one solution to improve nurses' perceptions

Assessing Nurses' Knowledge and Performance Regarding Shift Report Handover

Background: Handover facilitate the safe transfer of patient information in organization, the transfer of patient information into a logical format to reduce the omission of important information and to facilitate consistency in the process. Aim to assess nurses' knowledge and performance regarding shift report handover. Study design: A descriptive design was used to carry out the study. Setting: This study was conducted in the Cardiac and Digestive System Center at Sohag City which affiliated to Ministry of Health (MOH). Subject: The study included (45) staff nurses. Tools: Two tools of data collection were used namely; first tool knowledge questionnaire which divided into two parts: part 1 included questions about personal characteristics of the staff nurses, part 2 consisted of multiple choice questions; and second tool an observational checklist. Results: The main study results illustrated that majority of studied nurses had very deficient total knowledge regarding shift report handover and low of performance regarding shift report handover. Conclusion: the staff nurses in the study setting have deficient knowledge and inadequate performance of communication and shift report handover. There were significant positive correlation between knowledge score and performance score. Recommendations: Hospital decision makers should create strategies to manage the quality of shift handover. The applicability of shift report handover should be supported from the hospitals administration.

Handover From the Emergency Department to Inpatient Units: A Quality Improvement Study.

Intrahospital handovers are high risk. Standardization of content and process is recommended. Emergency department to inpatient unit handovers were inefficient. The intervention was a standardized operating protocol, including checklist and procedures. The intervention was coproduced and prototyped. Handovers were observed for intervention adherence, and the Handover Evaluation Scale was used to measure nurses' perceived quality of handover. The handover had 3 steps. Step 1 had more content, prompting by the receiver, and family participation postintervention. Step 3 was shorter in duration, had less content, and occurred at the bedside more postintervention. Receiving nurses were able to ask questions and found that information provided was timely, current, and easy to follow. Sending nurses perceived that handover was less succinct postimplementation, despite decreases in handover duration and repetition of information. This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.

Improving the quality of trauma meetings by implementation of a modern trauma management platform

Trauma meetings constitute the majority of clinical decision-making for new referrals and also act as a crucial tool to coordinate the trauma theatre list. Incorporation of electronic technology has been...

Assessment and improvement of junior doctor handover in the emergency department

IntroductionEffective handover between junior doctors is widely accepted as essential for patient safety. The British Medical Association in association with the National Health Service (NHS) National Patient Safety Agency and...

Weekend handover: Improving patient safety during weekend services

Clinical Handover has been identified as one of the most high-risk processes within medicine. Inadequate handover is a significant cause of avoidable adverse events across many hospitals. A likert-survey of the weekend handover system at a district general hospital demonstrated significant dissatisfaction amongst junior doctors. Intending to improve patient safety and reduce stress for on-call junior doctors, a weekend handover proforma was compiled according to the Royal College of Physicians and Surgeons guidelines. The proforma was trialed on six medical wards for six months with a before and after questionnaire being sent to doctors on the wards involved to determine the proforma’s merits on a scale of 1 (least effective) to 10 (most effective). Reports subsequent to implementation demonstrated a 67% increase ease of identifying outstanding weekend jobs. 57% of doctors reported better understanding of their patient’s diagnosis and management plan and 53% stated it was easier to identify the patients that required regular medical review over the weekend. Results also highlighted a 55% reported an increase in safety of weekend handovers (p<0.01). A closed loop audit of handover practice through the use of a standardised proforma showed improved quality, detail and consistency of handovers. The reduction in stress for junior doctors managing unknown patients with a clear concise plan, directed by a senior from the parent team during the week, has improved patient safety and doctor satisfaction.

Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU

PurposeStandardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received...

Analysis of Signal Quality on Intra and Inter Handover Performance on the 4G LTE Network using the SSV Method

One of the advantages of mobile communication is Handover. The research data can be used to identify network problems such as weak signal level (RxLev), poor signal quality (Rx Qual), etc. which cause the handover quality at that site in certain areas to be affected as well. The purpose of this research is to determine the quality of a signal that will affect the performance of the handover frequency both intra-frequency handover and inter-frequency handover on the 4G LTE network by paying attention to the KPI Site of the relevant vendor, in this case PT.GCI Indonesia. The method used to determine the signal quality and network performance in an area, namely measuring and retrieving data with a drive test. One of the data collection techniques on the 4G network is to use the SSV (Single Site Verification) method on the drive test so that the signal quality and handover analysis are known both intra handover and inter handover using the GENEX Probe software. From the results of this study, it was found that the signal quality and handover quality of the 4G LTE network met the standardization given by the KPI, for the requirements for the success of the handover, which was 100% with the signal quality of the RSRP and SINR parameters resulting in a percentage of 73% and 91.21% according to the standards desired by the operator. and vendors using the Single Site Verification (SSV) drive test method.

Physician-to-Nurse Handover: A Systematic Review on the Effectiveness of Different Models.

Effective professional communication and accurate transfer of relevant clinical information are crucial components of healthcare delivery. National and international health authorities strongly recommend the adoption of effective handover practice. Still, scant evidence is available on the impact of different multiprofessional handover models. We carried out a systematic review following the Prepared Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool, and critically appraise the available evidence on the effectiveness of different physician-to-nurse handover models adopted in inpatient settings. We identified 1.243 citations searching the databases Medline, Embase, and CINAHL. After screening, 10 studies were included in the review reporting results on the effectiveness of 8 different handover models, measured on 44 different outcomes, grouped into: (1) process of care and efficiency outcomes, (2) patients' outcomes, and (3) healthcare professionals-related outcomes. Overall, applying structured handover tools improve healthcare practice and selected outcomes; however, not only solid evidence on the effectiveness of different handover models is scant but also global consensus is lacking on which standardized measures and indicators to use to assess their impact. In times of healthcare delivery models of growing complexity, multiprofessional handover is a key component of care paths. Although there is overall consensus on the need for improving the quality and safety of multiprofessional handover, the evidence on the tools available to achieve it and the metrics to measure their impact is heterogeneous. We urge that rigorous studies are conducted to inform the planning, implementation, and monitoring of effective handover, with the ultimate aim of improving quality of care and patient safety.

Adverse Outcomes Associated With Intraoperative Anesthesia Handovers: A Systematic Review and Meta-analysis

PurposeWhether intraoperative handover of anesthesia care increases the risk of adverse outcomes in patients undergoing surgery remains unclear. This systematic review aimed to synthesize the evidence on the association of intraoperative anesthesia handover with delivery of patient care and patient outcomes. DesignThis is a systematic review and meta-analysis. MethodsA comprehensive search was conducted to identify the eligible studies examining the association between intraoperative anesthesia handover and adverse outcomes in patients receiving surgery. The cohort studies and case-control studies were included. The methodological quality of each included study was assessed using the Newcastle-Ottawa Scale. The meta-analysis across the studies was performed using Review Manager. Adjusted odds ratio (aOR) with 95% confidence intervals were used for dichotomous variables. Sensitivity analysis was conducted by removing one study each time and re-estimating the overall effect size. FindingsSeven retrospective cohort studies with 680,155 patients were finally included. Among these participants, 139,362 patients (20.49%) had anesthesia handovers during their surgeries. In pooled analysis, the statistically significant relationship between intraoperative anesthesia handover and composite morbidity was observed (aOR 1.20 and 95% CI 1.12-1.28). However, the number of handovers was not significantly associated with composite of mortality and morbidity (aOR 1.12, 95% CI 1.00-1.25) and in-hospital mortality (aOR 1.26, 95% CI 0.96-1.67). ConclusionsThe findings suggested that each additional intraoperative anesthesia handover increased the odds of composite morbidity. It is important to improve the handover quality and avoid handovers when anesthesia providers have high-risk care events, patients having unstable status, or inadequate handover time.

P079: Clinical handover from emergency medical services to the trauma team: A gap analysis

Background: Clinical handover between emergency medical services (EMS) and the hospital trauma team can be subject to errors that may negatively affect patient care. Thus far, there has been limited evaluation of the quality of EMS handover. As such, we sought to characterize handover practices from EMS to the trauma team, identify areas for improvement, and determine if there is a need for standardization of current handover practices. Aim Statement: Identify areas for improvement in handover from EMS to the trauma team, specifically examining handover content, structure, and discordances between different team members regarding handover expectations. Measures &amp; Design: Data were prospectively collected over a nine week period by a trained observer at Canada's largest level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders (TTLs) and EMS according to a bidirectional Likert scale. Evaluation/Results: Of 410 trauma team activations, 79 verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Only 28% of handovers had a dedicated question and answer period. Of all questions asked, 35% were questioning previously given information. EMS returned to categories of information unprompted in 84% of handovers. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking, which was associated with a greater number of interrupting questions from the trauma team (3.15 vs. 1.82, p =.001). There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders. Discussion/Impact: At our trauma centre, we have identified the need for handover standardization due to poor information content, a lack of structure and active listening, significant information repetition, and discordant expectations between EMS, nurses, and TTLs. We intend to use our results to guide the development of a co-constructed framework integrating the perspectives of all team members on the trauma team.

Factors Correlated With Quality Of Patient’s Handover In Inpatient Room Of The Hospital

Background: Communication failure during handover is the main cause of the patient's injury and is the root cause of 65% of the sentinel incident. Bad handover is assumed to have correlation with clinical diagnosis inaccuracies, delay in diagnosis, delay in laboratory tests, treatment errors, inconsistent or misinterpretation of results, duplication of tests, increase in complications of the Hospital.Purpose: This study aimed to determine the factors related to the quality of the patient's handover in inpatient room of the hospital.Methods: This research used a correlational analysis study with a cross sectional approach. Data retrieval use questionnaires and observation sheets. The number of samples on this study is 79 nurses taken in random sampling techniques. Statistical analysis used is a test of spearman rank.Results: The result of this research revealed that most of the respondents (69.6%) are diploma graduates, and 72.2% of respondents have a working time of &lt; 5 years. Almost all respondents (93.7%) have good motivation, and 94.9% of respondents have good handover quality. The last educational variable (p = 0.388) and the nurse’s working time (P = 0.209) are not related to the quality of the handover, while the motivation (P = 0.000) and the implementation of the chief nurse’s supervision (P = 0.000) relate to the quality of the handover between the shifts in the inpatient room of the hospital.Conclusion of this study is the motivation and the implementation of the chief nurse’s supervision relate to the quality of the handover between the shifts in the inpatient room of the hospital. Hospital’s management is expected to raise the motivation of nurses in conducting handover and enhancing the supervision of the chief nurse to improve the quality of the patient's handover and minimize the errors in information exchange conducted by nurses

Quality of collaboration and information handovers in palliative care: a survey study on the perspectives of nurses in the Southwest Region of the Netherlands.

BackgroundWhen patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses.MethodsWe performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test.ResultsA total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics.ConclusionNurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.