Structured Handover Tool Research Articles

Effectiveness of a structured handover tool (I-PASS + C) in patients transferred out from pediatric intensive care unit to ward: A single-center, prospective observational study from Western India

Abstract Background: Handover is a process of communication between physicians and, thus, integral to medical practice. Communication failures commonly cause preventable medical errors and adverse events. This study was done to evaluate the effectiveness of a structured handover tool. Subjects and Methods: It is a prospective observational study conducted in pediatric intensive care unit (PICU) of tertiary care hospital of Western India. The errors were noticed in the handover process of patients who were transferred from the PICU to the pediatric ward. A modified handover tool I-PASS + C was implemented as an intervention. The outcome was measured in the form of changes in the number of errors postintervention. Results: The handovers enrolled in the control group were 46 (28.04%) and 40 (24.39%) in the intervention group. Patient’s age ranged from 3 months to 205 months. “Not mentioning information regarding counseling and parent’s response/behavior” and “no cross check by hearing back from the receiver” were the most commonly noticed errors in 40 (86.9%) and 31 (67.4%) patients, respectively, which reduced significantly in the intervention group. Other commonly noticed errors during the stay in the ward were “got phone call from ward to take further information” in 16 (34.78%) patients, followed by “medical errors reported in ward” in 8 (17.4%) patients, which also reduced significantly in the intervention group. Conclusions: A structured handover tool reduces the errors of the handover process as well as adverse events, after transferring the patient from the PICU to the ward.

A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study.

An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect. This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover. A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = -3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to -0.011 (95% CI, -0.01 to -0.018; P < 0.001). Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect.

Improving Transitions of Care between the Intensive Care Unit and General Internal Medicine Ward. A Demonstration Study.

Background: In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward.Objective: To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward.Methods: This was a pre–post intervention study at a tertiary academic hospital. We developed and implemented a user-designed, structured, handwritten ICU-to-GIM transfer tool. The tool included active medical issues, functional status, medications and medication changes, consulting services, code status, and emergency contact information. Transfer tool users included GIM physicians, ICU physicians, and critical care rapid response team nurses. An implementation audit and mixed qualitative and quantitative analysis of pre–post survey responses was used to evaluate clinician satisfaction and the perceived quality of patient transfers.Results: The pre–post survey response rate was 51.8% (99/191). Respondents included GIM residents (58.5%), ICU rapid response team physicians and nurses (24.2%), and GIM attending physicians (17.2%). Less than half of clinicians (48.8%) reported that the preintervention transfer process was adequate. Clinicians who used the transfer tool reported that the transfer process was improved (93.3% vs. 48.8%, P = 0.03). Clinician-reported understanding of medication changes in the ICU increased (69.2% vs. 29.1%, P = 0.004), as did their ability to plan for a safe hospital discharge (69.2% vs. 31.0%, P = 0.01). However, only 64.2% of audited transfers used the tool. Frequently omitted sections included home medications (missing in 83.4% of audits), new medications (33.3%), and secondary diagnosis (33.3%). Thematic analysis of free-text responses identified areas for improvement including clarifying the course of ICU events and enhancing tool usability.Conclusion: A user-designed, structured, handwritten transfer tool may improve the perceived quality of patient transfers from the ICU to the GIM wards.

A collaborative approach to the implementation of a structured clinical handover tool (iSoBAR), within a hospital setting in metropolitan Western Australian: A mixed methods study.

The aim of this study was to determine the effectiveness of an education intervention for the implementation of the clinical handover tool iSoBAR, in an acute setting. A quantitative, descriptive survey design, using pre and post survey data before and after the implementation of an education intervention was used. Twenty nine nurses, doctors and allied health personnel employed at the study site participated in the study. The educational intervention consisted of an electronic presentation plus simulated video recorded exemplars of clinical handover. Outcome measures were the efficacy of the education intervention on the confidence of practitioners using the iSoBAR handover tool. Participants' understanding of the iSoBAR tool using Mann-Whitney U test was 2.54 pre-intervention and 4.32 post-intervention. Confidence in using the tool also increased post educational intervention from 2.7 (pre-intervention) to 4.07 (post-intervention). Focus groups identified several factors relating to the implementation of iSoBAR, creating two dominant themes: challenges concerning patient factors and change management processes and systems. Opportunities were identified: Practice enhancement, patient centred care, professional practice, and grassroots initiatives. The use of an interprofessional educational program increased the confidence and understanding of a range of health care practitioners when using the clinical handover tool iSoBAR.

Using the Plan-Do-Study-Act cycle to manage interruptions during nursing team leader handover in the intensive care unit: Quality improvement project

Introduction: Intensive care unit (ICU) nursing team leader (TL) handover is a process that is at risk for miscommunication, compromising patient safety. Interruptions during this process have the potential to increase miscommunication. Bedside handover and use of a structured handover tool are two strategies advocated internationally to improve safety of handover.

Improving clinical handover in retrieval

Clinical handover was identified as a root cause of major healthcare incidents across NSW and thus mandated for change. NETS NSW is the dedicated retrieval service for newborns and children in NSW and the ACT. Handover is fundamental for decision-making in retrieval where direct clinical contact is not possible. A patient retrieval involves multiple handovers. It is essential information is exchanged in a coordinated and systematic way to minimise risk of error from poor communication to enhance safe, timely patient transfer. Literature on optimising retrieval handover is sparse. Aims were to standardise and improve clinical communication during handover. A four phase study was conducted: data gathering from focus groups and observations of handovers; tool development; implementation of tools evaluation. Focus groups revealed retrieval clinicians experienced inadequate handovers from referring clinicians during the initial call to NETS when retrieval decisions are made. Inexperienced and junior clinicians called NETS with limited patient information, without a structured handover tool, and no guide for information NETS required. When conferencing with receiving units prior to team departure, identified problems included multiple handovers when shifts and accepting clinicians changed.

An Audit of the Efficacy of a Structured Handover Tool in Obstetric Anaesthesia

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G443(P) “CHAPS” handover tool in Paediatric setting

IntroductionEffective handover is vital for patient safety and good patient care. With shift patterns and junior members of staff with variable experience in Paediatrics, a structured handover tool is essential...

An audit of the efficacy of a structured handover tool in obstetric anaesthesia

IntroductionThe SAFE handover tool was developed to reduce critical omissions during handovers in obstetric anaesthesia. It comprises a simple proforma onto which the outgoing team documents patients who fall into one of four anaesthetically relevant categories: Sick patients; At-risk patients (of emergency caesarean section, major haemorrhage or anaesthetic problems); Follow-ups; and Epidurals. We hypothesised that its use would reduce the number of critical omissions at handover. MethodsThe efficacy of the SAFE handover tool was assessed through several audit cycles in a single maternity unit. The four SAFE categories were considered the gold standard, since they encompassed the consensus opinion of senior obstetric anaesthetists with respect to parturients they most wanted to know about at handover. Against these criteria it was possible to compare the number of cases that should have been handed-over against the number that were actually handed-over. ResultsAfter implementation of the handover tool, patients were four times more likely to be handed-over than without the use of the tool: an increase from 49% to 79% of relevant cases (P<0.0001, OR 4.1, 95% CI 2.19–7.6). The handover tool was particularly effective at increasing the handover rates of Sick and At-risk parturients, which increased from 21% to 67% (P<0.0001, OR 7.7, 95% CI 2.7–21.7) and 25% to 78% (P<0.01, OR 9.9, 95% CI 1.6–61.6), respectively. ConclusionThe SAFE handover tool significantly increased handover rates of anaesthetically relevant parturients. It is easy to remember and consistent with UK National Health Service Litigation Authority’s guidance on risk management in maternity units.

Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient

Clinical communication and recognising and responding to a deteriorating patient are key current patient safety issues in healthcare. The aim of this literature review is to identify themes associated with aspects of the hospital clinical handover between paramedics and ED staff that can be improved, with a specific focus on the transfer of care of a deteriorating patient. Extensive searches of scholarly literature were conducted using the main medical and nursing electronic databases, including Cumulative Index to Nursing and Allied Health Literature, Medline and PubMed, during 2011 and again in July 2012. Seventeen peer-reviewed English-language original quantitative and qualitative studies from 2001 to 2012 were selected and critically appraised using an evaluation tool based on published instruments. Relevant themes identified were: professional relationships, respect and barriers to communication; multiple or repeated handovers; identification of staff in the ED; significance of vital signs; need for a structured handover tool; documentation and other communication methods and education and training to improve handovers. The issues raised in the literature included the need to: produce more complete and concise handovers, create respectful and effective communication, and identify staff in the ED. A structured handover tool such as ISBAR (a mnemonic covering Introduction, Situation, Background, Assessment and Recommendations) would appear to provide a solution to many of these issues. The recording of vital signs and transfer of these data might be improved with better observation systems incorporating early warning strategies. More effective teamwork could be achieved with further clinical communications training.

Using a structured handover tool for improving transition of patient care from operating room (OR) to post anesthetic care unit (PACU)

1Major Operating Theatre (Orthopedics Scrub), National University Hospital, Singapore, 2National University Hospital, Major Operating Theatre (PACU), 3National University Hospital, Evidence-Based Nursing Unit, Singapore

Standardized postoperative handover process improves outcomes in the intensive care unit

To determine whether structured handover tool from operating room to pediatric cardiac intensive care unit following cardiac surgery is associated with a reduction in the loss of information transfer and an improvement in the quality of communication exchange. In addition, whether this tool is associated with a decrease in postoperative complications and an improvement in patient outcomes in the first 24 hrs of pediatric cardiac intensive care unit stay. Prospective observational clinical study. Pediatric cardiac intensive care unit of an academic medical center. Pediatric cardiac surgery patients over a 3-yr period. Evaluation of communication and patients studied for two time periods: verbal handover (July 2007-June 2009) and structured handover (July 2009-June 2010). None. Two anonymous surveys administered to the entire clinical team of the pediatric cardiac intensive care unit evaluated loss of information transfer for each of the two handover processes. Quality of structured handover tool was evaluated by Likert scale responses in the second survey. Patient complications including cardiopulmonary resuscitation, mediastinal reexploration, placement on extracorporeal membrane oxygenation, development of severe metabolic acidosis, and number of early extubations in the first 24-hr pediatric cardiac intensive care unit stay were compared for the two time periods. Survey results showed the general opinion that the structured handover tool was of excellent quality to enhance communication (Likert scale: 4.4 ± 0.7). In addition, the tool was associated with a significant reduction (p < .001) in loss of information for every category of patient clinical care including patient, preoperative, anesthesia, operative, and postoperative details and laboratory values. Patient data revealed significant decrease (p < .05) for three of the four major complications studied and a significant increase (p < .04) in the number of early extubations following introduction of our standardized handover tool. In this setting, a standardized handover tool is associated with a decrease in the loss of patient information, an improvement in the quality of communication during postoperative transfer, a decrease in postoperative complications, and an improvement in 24-hr patient outcomes.

Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods

BackgroundHandover of patient information represents a critical time period during a patient's hospitalisation. While recent guidelines promote standardised communication during these patient care transitions, significant variability in structure and practice...

A ‘modified’ CHAPs tool – an effective system for handover of care between medical staff in a maternity unit setting

Effective communication is central to promoting patient safety and reducing the number of serious clinical incidents. CNST (Clinical Negligence Scheme for Trusts) Maternity Standard 4-criterion 8 requires a maternity service...