Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods
ABSTRACT Handover 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 persists among hospitals and providers.
The authors surveyed internal medicine residents regarding handover practices before and after introduction of a structured, web-based handover application. The handover application standardised patient data in a format suitable for both patient handovers and day-to-day patient management.
A total of 80 residents were surveyed prior to the intervention (80% response rate) and 161 residents during the intervention (average 68% response rate for all surveys distributed). At baseline, residents perceived deficits in handover practices related to the variability of information transferred and correlated that variability to near-miss events. After introduction of the handover application, 100% of handovers contained an updated problem list, active medications, and code status (compared to <55% at baseline, p<0.01); residents perceived approximately half as many near-miss events on call (31.5% vs 55%; p=0.0341) and were twice as likely to respond that they were confident or very confident in their patient handovers compared to traditional practices (93% vs 49%; p=0.01).
Standardisation of information transmitted during patient handovers through the use of a structured, web-based application led to consistent transfer of vital patient information and was associated with improved resident confidence and fewer perceived near-miss events on call.
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ABSTRACT: AimTo examine the relation between the strategies the nurses employ during handover and the number and types of treatment errors in patient care in the following shift.Background Patient handover has repeatedly been declared an area of considerable vulnerability to patient safety. This study examined factors that affect treatment errors in patient care, including the use of handover strategies from high reliability organizations.DesignProspective study.Method Data were collected in 2012–2013 from 200 randomly selected handovers in five internal wards. Handover strategies previously adopted from High Reliability Organizations were assessed via observations; treatment errors – dosage discrepancy, order postponed, no documentation – captured from the patient's files and demographical data were collected via questionnaires.FindingsOn average, in nearly one-fifth of the patient's files, medication dosage given was inaccurate; in nearly one-third a care order was fulfilled late; and in nearly half, documentation was partially missing. Rate of use of handover strategies previously adopted from high reliability organizations varied substantially. Results of negative binomial regression analysis revealed that face-to-face verbal update with interactive questioning, update from practitioners other than the outgoing, topics initiated by incoming and outgoing team, including the latter's stance on care plans and writing a summary prior to handover, were significantly and negatively linked to number of treatment errors (P < 0·05).Conclusions Nursing handover is an opportunity for nurses to prevent errors and unsafe practice by implementing more risk-aware handover strategies. Implications for facilitating the use of such strategies are discussed.Journal of Advanced Nursing 01/2015; DOI:10.1111/jan.12615 · 1.69 Impact Factor
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ABSTRACT: Patients with complex health conditions frequently require care from multiple providers and are particularly vulnerable to poorly executed transitions from one healthcare setting to another. Poorly executed care transitions can result in negative patient outcomes (e.g. medication errors, delays in treatment) and increased health care spending due to re-hospitalization or emergency room visits by patients. Little is known about care transitions from acute care to complex continuing care and rehabilitation settings. Thus, a qualitative study was undertaken to explore clinicians' perceptions of strategies aimed at improving patient care transitions from acute care hospitals to complex continuing care and rehabilitation health-care organizations. A qualitative study using semi-structured interviews was conducted with clinicians employed at two selected healthcare facilities: an acute care hospital and a complex continuing care/rehabilitation organization, respectively. Analysis of the transcripts involved the creation of a coding schema using the content analyses outlined by Ryan and Bernard. In total, 31 interviews were conducted with clinicians at the participating study sites. Three themes emerged from the data to delineate what study participants described as strategies to ensure quality inter-organizational transitions of patients transferred from acute care to the complex continuing care and rehabilitation hospital. These themes are: 1) communicating more effectively; 2) being vigilant around the patients' readiness for transfer and care needs; and 3) documenting more accurately and completely in the patient transfer record. Our study provides insights from the perspectives of multiple clinicians that have important implications for health care leaders and clinicians in their efforts to enhance inter-organizational care transitions. Of particular importance is the need to have a collective and collaborative approach amongst clinicians during the inter-organizational care transition process. Study findings also suggest that the written patient transfer record needs to be augmented with a verbal report whereby the receiving clinician has an opportunity to discuss with a clinician from the acute care hospital the patient's status on discharge and plan of care. Integral to future research efforts is designing and testing out interventions to optimize inter-organizational care transitions and feedback loops for complex medical patients.BMC Health Services Research 07/2013; 13(1):289. DOI:10.1186/1472-6963-13-289 · 1.66 Impact Factor
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ABSTRACT: Changing demographics and pressures on the healthcare system mean that more older people with complex medical problems need to be supported in primary and community care settings. The challenge of managing medicines effectively in frail elderly patients is considerable. Our research investigates what can go wrong and why, and seeks insight into the context that might set the scene for system failure.BMJ Open 07/2014; 4(7):e005302. DOI:10.1136/bmjopen-2014-005302 · 2.06 Impact Factor