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1.
Med J Aust. 2019 Jan 18. doi: 10.5694/mja2.12107. [Epub ahead of print]

Identifying the cultural heritage of patients during clinical handover and in hospital medical records.

Author information

1
South Metroplitan Health Service, Perth, WA.
2
Health Consumers' Council (WA), Perth, WA.
3
John Curtin Institute of Public Policy, Curtin University, Perth, WA.

Abstract

OBJECTIVE:

To examine the frequency of and rationale for hospital doctors mentioning a patient's cultural heritage (ethnicity, national heritage, religion) during medical handovers and in medical records.

DESIGN:

Four-phase observational study, including the covert observation of clinical handovers in an acute care unit (ACU) and analysis of electronic medical records (EMRs) of ACU patients after their discharge to ward-based care.

SETTING, PARTICIPANTS:

1018 patients and the doctors who cared for them at a tertiary hospital in Western Australia, May 2016 - February 2018.

MAIN OUTCOME MEASURE:

References to patients' cultural heritage by ACU doctors during clinical handover (written or verbal) and by ward-based doctors in hospital EMRs (written only), by geographic ethnic-national group.

RESULTS:

In 2727 ACU clinical handovers of 1018 patients, 142 cultural heritage identifications were made (ethnicity, 84; nationality, 41; religion, 17); the rate was highest for Aboriginal patients (370 [95% CI, 293-460] identifications per 1000 handovers). 14 505 EMR pages were reviewed; 380 cultural heritage identifications (ethnicity, 257; nationality, 119; religion, 4) were recorded. A rationale for identification was documented for 25 of 142 patients (18%) whose ethnic-national background was mentioned during handover or in their EMR. Multivariate analysis (adjusted for demographic, socio-economic and medical factors) indicated that being an Aboriginal Australian was the most significant factor for identifying ethnic-national background (handovers: adjusted odds ratio [aOR], 21.7; 95% CI, 7.94-59.4; hospital EMRs: aOR, 13.6; 95% CI, 5.03-36.5). 44 of 75 respondents to a post-study survey (59%) were aware that Aboriginal heritage was mentioned more frequently than other cultural backgrounds.

CONCLUSIONS:

Explicitly mentioning the cultural heritage of patients is inconsistent and seldom explained. After adjusting for other factors, Aboriginal patients were significantly more likely to be identified than patients with other backgrounds.

KEYWORDS:

Cultural competency; Ethnic groups; Health communication; Indigenous health; Physician-patient relations; Population characteristics; Racism; Religion; Social determinants of health

2.
J Perinatol. 2019 Jan 17. doi: 10.1038/s41372-018-0305-6. [Epub ahead of print]

Impact of patient handover structure on neonatal perioperative safety.

Author information

1
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. dan.france@vumc.org.
2
Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, USA. dan.france@vumc.org.
3
Department of Pediatrics, Division of Neonatology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. dan.france@vumc.org.
4
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
5
Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, USA.
6
Department of Pediatrics, Division of Neonatology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
7
Department of Pediatrics, Division of Neonatology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
8
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
9
Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
10
Neonatal Intensive Care Unit, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
11
Perioperative Services, Vanderbilt University Medical Center, Nashville, TN, USA.
12
Neonatal Intensive Care Unit, Nationwide Children's Hospital, Columbus, OH, USA.

Abstract

OBJECTIVE:

To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates.

STUDY DESIGN:

A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care.

RESULTS:

The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers.

CONCLUSIONS:

NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.

Grant support

Grant support

3.
BMC Med Educ. 2018 Dec 29;18(1):322. doi: 10.1186/s12909-018-1435-4.

Perceived strain of undergraduate medical students during a simulated first day of residency.

Author information

1
Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
2
Faculty of Medicine, University of Augsburg, Deanery, Augsburg, Germany.
3
TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany.
4
Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. harendza@uke.de.
5
Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Martinistr. 52, D-20246, Hamburg, Germany. harendza@uke.de.

Abstract

BACKGROUND:

Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident's first day in hospital.

METHODS:

Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated, n = 35 versus non-VI: not vertically integrated, n = 26) and different academic advancement (semester 10, n = 26 versus final year, n = 41) were compared.

RESULTS:

All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation (p < .05) after the consultation hour compared to students from a VI curriculum and compared to the management phase and the handover. No significant difference in perceived strain was found between students from semester 10 compared to final year students.

CONCLUSIONS:

During the consultation hour and the handover with a colleague medical students faced tasks which are familiar to them from undergraduate education. Their higher strain levels during the management phase might occur because they are confronted with unfamiliar tasks and decisions. Feeling responsible for the right actions in this phase of multitasking and professional interaction might have added to the strain students perceived during this phase. Patient management should be emphasized more in any type of undergraduate medical curriculum.

KEYWORDS:

360-degree examination; Assessment; Consultation; Curriculum; Handover; Patient management; Residency; Strain; Undergraduate medical education

4.
Rev Esc Enferm USP. 2018 Dec 13;52:e03401. doi: 10.1590/S1980-220X2018006203401.

Features of recording practices and communication during nursing handover: a cluster analysis.

Author information

1
Technological Educational Institute of Crete, 3School of Health and Welfare Services, Department of Nursing, Heraklion, Greece.
2
University of Crete, Faculty of Medicine, Department of Social Medicine, Heraklion, Greece.

Abstract

OBJECTIVE:

To record and identify the characteristics of nursing handovers in a tertiary hospital.

METHOD:

Observational study. Twenty-two nurses participated in 11 nursing handovers in 2015/16, using a recorded audio system and an unstructured observation form. Hierarchical cluster analysis was performed.

RESULTS:

Thirty characteristics were identified. The nursing handovers were based on the clinical status of patients, and all nurses obtained specialized scientific knowledge specific to the clinical environment. The information used was not based on nursing diagnoses and not in accordance with best nursing clinical practice. The following four clusters emerged among the 30 characteristics: 1) the use of evidence-based nursing practice, 2) the nonuse of evidence-based nursing practice and its correlation with strained psychological environment, 3) patient management and the clinical skills/knowledge of nurses, and 4) handover content, quality of information transferred and specialization.

CONCLUSION:

Multiple characteristics were observed. The majority of characteristics were grouped based on common features, and 4 main clusters emerged. The investigation and understanding of structural relations between these characteristics and their respective clusters may lead to an improvement in the quality of nursing health care services.

PMID:
30570086
DOI:
10.1590/S1980-220X2018006203401
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5.
J Emerg Nurs. 2018 Oct 24. pii: S0099-1767(18)30232-0. doi: 10.1016/j.jen.2018.09.007. [Epub ahead of print]

Implementing Bedside Handoff in the Emergency Department: A Practice Improvement Project.

Abstract

INTRODUCTION:

Handoff in the emergency department is considered a high-risk period for medical errors to occur. In response to concerns about the effectiveness of the nursing handoff in the emergency department of a Midwestern trauma center, a practice improvement project was implemented. The process change required nursing handoff at shift changes to be conducted at the bedside, using an adapted situation, background, assessment, recommendation (SBAR) communication tool.

METHODS:

For this project, the intervention effectiveness was measured using pre- and post-implementation scores on a nursing handoff questionnaire, selected items on the Hospital Survey on Patient Safety Culture, and handoff observations documented by nursing leadership.

RESULTS:

Questionnaire results revealed no change between pre- and post-implementation for 5 of the 7 questions. Responses to 2 questions showed improvement post-implementation. Scores from the Hospital Survey on Patient Safety Culture improved from 2015 to 2016. Observation data showed that some nurses needed prompting to perform the handoff at the bedside, and only 40% used the electronic medical record during handoff.

DISCUSSION:

Results showed that nurses found the SBAR bedside report method easy to use and prevented the loss of patient information more effectively than pre-intervention practice. Despite the strong evidence in the literature supporting bedside handoff, questions remain concerning its sustainability, as some nurses may resist such a change in the process of shift reporting.

KEYWORDS:

Effective handoff; Emergency department; Nursing bedside report; Nursing handoff; Nursing report; Observation; Self-report

6.
PLoS One. 2018 Dec 5;13(12):e0207511. doi: 10.1371/journal.pone.0207511. eCollection 2018.

Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: A mixed-methods study.

Author information

1
Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom.
2
Public Health Foundation of India, New Delhi, Delhi, India.
3
Centre for Chronic Disease Control, New Delhi, Delhi, India.
4
Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
5
Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
6
Academic Unit of Primary Care, University of Warwick, Coventry, UK.
7
Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.

Abstract

OBJECTIVES:

Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information.

METHODS:

A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources.

RESULTS:

Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents.

CONCLUSIONS:

Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.

Conflict of interest statement

The authors have declared that no competing interests exist.

7.
Ann Surg. 2018 Nov 29. doi: 10.1097/SLA.0000000000003137. [Epub ahead of print]

A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units: Findings From the Handoffs and Transitions in Critical Care (HATRICC) Prospective Cohort Study.

Author information

1
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
2
Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
4
Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
5
Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program, Indianapolis, IN.
6
Palliative and Acute Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
7
Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
8
Hospital of the University of Pennsylvania, Philadelphia, PA.
9
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
10
Family Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
11
Department of Anthropology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVE:

To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.

SUMMARY OF BACKGROUND DATA:

Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.

METHODS:

This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.

RESULTS:

We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.

CONCLUSION:

Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.

8.
BMC Health Serv Res. 2018 Nov 26;18(1):889. doi: 10.1186/s12913-018-3708-3.

The impact of patient safety culture on handover in rural health facilities.

Author information

1
UNE Business School University of New England, Armidale, NSW, 2351, Australia.
2
School of Health, University of New England, Armidale, NSW, 2351, Australia. jlea2@une.edu.au.
3
School of Health, University of New England, Armidale, NSW, 2351, Australia.

Abstract

BACKGROUND:

Effective handover is crucial for patient safety. Rural health care organisations have particular challenges in relation to handover of information, placing them at higher risk of adverse events. Few studies have examined the relationship between handover and patient safety in rural contexts, particularly in Australia. This study aimed to explore the effect of handover on overall perceptions of patient safety and the effect of other patient safety dimensions on handover in a rural Australian setting.

METHODS:

A cross-sectional online survey using The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was implemented across six rural Local Health Districts in NSW, Australia and resulted in 1587 respondents. Hierarchical multiple linear regression analysis was conducted to account for the nested nature of the data. Models were developed to assess the effect of handover on patient safety perceptions, and the effect of other patient safety culture composites on handover variables. Open-ended questions about patient safety were inductively analyzed for themes. Quotes from the handover theme are presented.

RESULTS:

All models were significant overall (p < .001), with explanatory powers ranging from 29 to 48%. Within rural health settings, effective handover is significantly related to patient safety perceptions (R2 = .29). A strong teamwork culture and management support culture was found to enhance effective handover of patient information (R2 = .47), and effective handover of personal responsibility (R2 = .37). A strong teamwork, management support, and open communication culture enhances handover of department accountability (R2 = .41). Despite the implementation of standardised communication tools and frameworks for handover, patient safety is compromised by inadequate coordination, poor or absent documentation between departments, between other health care agencies and in transfer of care from acute facilities to primary/community care.

CONCLUSION:

Approaches to handover need to consider the particular challenges associated with rurality and strengthening elements found to be associated with increased safety, such as a strong teamwork and management culture and good reporting practices. Research is required to examine how communication at transition of care, particularly between facilities, is conducted and ways in which to enhance patients' and families' participation.

KEYWORDS:

Handover communication; Patient safety; Patient safety culture; Rural health services

9.
Transl Pediatr. 2018 Oct;7(4):314-325. doi: 10.21037/tp.2018.08.01.

Going back to the ward-transitioning care back to the ward team.

Author information

1
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA.
2
Geriatrics & Palliative Care Division, Department of Family & Community Medicine, UC College of Medicine, Cincinnati, OH, USA.
3
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA.

Abstract

Transition of care from the intensive care unit (ICU) to the ward is usually an indication of the patient's improving clinical status, but is also a time when patients are particularly vulnerable. The transition between care teams poses a higher risk of medical error, which can be mitigated by safe and complete patient handoff and medication reconciliation. ICU readmissions are associated with increased mortality as well as ICU and hospital length of stay (LOS); however tools to accurately predict ICU readmission risk are limited. While there are many mechanisms in place to carefully identify patients appropriate for transfer to the ward, the optimal timing of transfer can be affected by ICU strain, limited resources such as ICU beds, and overall hospital capacity and flow leading to suboptimal transfer times or delays in transfer. The patient and family perspectives should also be considered when planning for transfer from the ICU to the ward. During times of transition, families will meet a new care team, experience uncertainty of future care plans, and adjust to a different daily routine which can lead to increased stress and anxiety. Additionally, a subset of patients, such as those with new technology, require additional multidisciplinary support, education and care coordination which can contribute to longer hospital LOS if not addressed proactively early in the hospitalization while the patient remains in the ICU. In this review article, we describe key components of the transfer from ICU to the ward, discuss current strategies to optimize timing of patient transfers, explore strategies to partner with patients and families during the transfer process, highlight patient populations where additional considerations are needed, and identify future areas of exploration which could improve the care transition from the ICU to the ward.

KEYWORDS:

ICU discharge; ICU readmission; ICU transfer; Pediatric intensive care unit; handoff; medication reconciliation

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Publication type

Publication type

10.
Am J Emerg Med. 2018 Nov 6. pii: S0735-6757(18)30911-2. doi: 10.1016/j.ajem.2018.11.003. [Epub ahead of print]

Improving handoff efficiency for admitted patients: A multidisciplinary, lean-based approach.

Author information

1
Department of Emergency Medicine, Massachusetts General Hospital, United States. Electronic address: bwhite3@partners.org.
2
Department of Medicine, Massachusetts General Hospital, United States.
3
Department of Emergency Medicine, Massachusetts General Hospital, United States.

KEYWORDS:

Emergency department performance; Emergency medicine; Handoff; Inpatient medicine; Process improvement

Publication type

Publication type

11.
J Eval Clin Pract. 2018 Nov 8. doi: 10.1111/jep.13063. [Epub ahead of print]

Development of a proforma to improve quality of handover of surgical patients at the weekend.

Author information

1
Department of Otorhinolaryngology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, UK.
2
Department of General Surgery, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, UK.

Abstract

RATIONALE, AIMS, AND OBJECTIVES:

The introduction of shift pattern of working in the medical profession has led to an increase in reliance on effective handover of patient information. We evaluated the use of a weekend handover proforma in General Surgical patients at a University Teaching Hospital.

METHODS:

A standardized weekend handover proforma was implemented. A pre-post survey of medical staff and prospective observational study on the use of the proforma was carried out. The impact of three strategies to reinforce change in clinical practice was investigated at random time-points. These were (1) presentation at a clinical governance meeting; (2) email; and (3) induction training on handover combined with one-to-one interactive training. The two outcome measures were compliance with the proforma, and "handover score," which was the amount of data transferred per patient.

RESULTS:

The survey highlighted inadequate provision for handover at the weekend. National guidelines were used to design the weekend handover proforma. There was 70% compliance with the new standardized proforma with a median handover score of 83% (IQR = 0-100). The results were presented at a clinical governance meeting, and the proforma was refined. After this change, the proforma was used in 71% of patients, and the median score was 65% (IQR = 0-80, P = 0.0516). Compliance after an email reminder was 69%, and median handover score was 80% (IQR = 0-90, P = 0.1037). After induction training, there was a significant improvement in proforma compliance (94%) and median score (90%, IQR = 80-90, P = 0.013).

CONCLUSION:

Effective transfer of handover information can be achieved over the weekend with the use of a standardized proforma. Use of the proforma was greatest after providing junior doctors with didactic training on handover combined with interactive guidance on completing the proforma.

KEYWORDS:

audit; handover; proforma; quality improvement; weekend

PMID:
30411446
DOI:
10.1111/jep.13063
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12.
Pilot Feasibility Stud. 2018 Oct 24;4:163. doi: 10.1186/s40814-018-0353-x. eCollection 2018.

Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses' handoffs using mobile devices.

Author information

1
1William F. Connell School of Nursing, Boston College, Chestnut Hill, MA USA.
2
Faculty of Nursing, Pavillon Marguerite d'Youville, C.P. 6128 succ. Centre-ville, Montreal, QC H3C 3J7 Canada.
3
3Center for Nursing Research, Jewish General Hospital, Montreal, Canada.
4
4Ingram School of Nursing, McGill University, Montreal, Canada.
5
5Department of Nursing, Jewish General Hospital, Montreal, Canada.
6
6Montreal Heart Institute, Montreal, Canada.

Abstract

Background:

The portability and multiple functionalities of mobile devices make them well suited for collecting field data for naturalistic research, which is often beset with complexities in recruitment and logistics. This paper describes the implementation of a research protocol using mobile devices to study nurses' exchanges of patient information at change of shift.

Methods:

Nurses from three medical and surgical units of an acute care teaching hospital in Montreal, Canada, were invited to participate. On 10 selected days, participants were asked to record their handoffs using mobile devices and to complete paper questionnaires regarding these exchanges. Nurse acceptance of mobile devices was assessed using a 30-item technology acceptance questionnaire and focus group interviews. The principal feasibility indicator was whether or not 80 complete handoffs could be collected on each unit.

Results:

From October to December 2017, 63 of 108 eligible nurses completed the study. Results suggest that the use of mobile devices was acceptable to nurses, who felt that the devices were easy to use but did not improve their job performance. The principal feasibility criterion was met, with complete data collected for 176, 84, and 170 of the eligible handoffs on each unit (81% of eligible handoffs). The research protocol was acceptable to nurses, who felt the study's demands did not interfere with their clinical work.

Conclusions:

The research protocol involving mobile devices was feasible and acceptable to nurses. Nurses felt the research protocol, including the use of mobile devices, required minimal investment of time and effort. This suggests that their decision to participate in research involving mobile devices was based on their perception that the study protocol and the use of the device would not be demanding. Further work is needed to determine if studies involving more sophisticated and possibly more demanding technology would be equally feasible and acceptable to nurses.

KEYWORDS:

Acceptability; Feasibility; Handoff; Mobile devices; Nursing; Recruitment; Research procedure

Conflict of interest statement

Patrick Lavoie was a Postdoctoral Fellow, William F. Connell School of Nursing, Boston College, USA, at the time of the study. He currently is an Assistant Professor, Faculty of Nursing, Université de Montréal, Canada. Sean Clarke is a Professor and Associate Dean for Undergraduate Programs, William F. Connell School of Nursing, Boston College, USA. Christina Clausen is a Coordinator of professional development and knowledge translation initiatives in the Nursing Department at the Jewish General Hospital and a Faculty Lecturer at the Ingram School of Nursing, McGill University, Canada. Margaret Purden is an Associate Professor at the Ingram School of Nursing, McGill University, and Scientific Director of the Center for Nursing Research of the Jewish General Hospital, Canada. Jessica Emed is a Clinical Nurse Specialist (quality and professional development) and Faculty Lecturer at the Ingram School of Nursing, McGill University, Canada. Tanya Mailhot is a Postdoctoral Fellow, Faculty of Nursing and Faculty of Medicine, Université de Montréal, and Montreal Heart Institute, Canada. Valerie Frunchak is an Associate Nursing Director (professional practice and academic affairs) at CIUSSS West-Central, and an Assistant Professor at the Ingram School of Nursing, McGill University, Canada.This study was approved by the Medical/Biomedical Research Ethics Committee of the Integrated Health and Social Services University Network for West-Central Montreal Health (CODIM-MBM-17-096). Upon enrolment, all participants provided written informed consent for study participation and publication. Verbal consent was sought again from the participants prior to all forms of data collection.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

13.
Int J Health Care Qual Assur. 2018 Aug 13;31(7):845-854. doi: 10.1108/IJHCQA-08-2017-0148.

Improving out-of-hours surgical patient care.

Author information

1
Royal Brompton and Harefield NHS Foundation Trust, London, UK.
2
Whipps Cross University Hospital , London, UK.
3
Barking Havering and Redbridge University Hospitals NHS Trust , London, UK.
4
Barts Health NHS Trust, London, UK.

Abstract

PURPOSE:

The Royal College of Surgeons recognises patient handover as the point at which patients are collectively at their most vulnerable. Concerns were raised in a London teaching hospital surgical department regarding an unstructured handover system, poor access to relevant clinical information, and inadequate weekend staffing. A quality improvement programme was designed and implemented to respond to these concerns and improve patient safety. The paper aims to discuss these issues.

DESIGN/METHODOLOGY/APPROACH:

A structured questionnaire was distributed to staff and results used to construct a diagram outlining the main factors influencing weekend patient safety. This framework was used to design changes, including a new electronic handover tool, regular handover meetings and additional weekend staff. Regular staff training was provided, and success was assessed in a continuous audit cycle with the results fed back to team leaders.

FINDINGS:

Over a three-month period, the handover meeting recorded an attendance rate consistently above 80 per cent. The electronic handover entries were scored according to seven criteria (correct layout; key information, i.e.: patient location, clinical priority, active issues, resuscitation status, test results and weekend plan), averaging between 42.2 and 92.9 per cent, with progressive improvement seen over the assessment period. Weekend staffing was increased by 50 per cent, allowing a dedicated team to care for stable inpatients and to oversee discharges.

ORIGINALITY/VALUE:

This improvement programme delivered lasting and significant change in response to staff concerns. It resulted in a more structured and reliable weekend system and established key mechanisms for dynamic performance feedback.

KEYWORDS:

Handover mechanisms; National Health Service; Patient safety; Quality improvement; Staffing; Surgery

14.
Medicine (Baltimore). 2018 Oct;97(41):e12798. doi: 10.1097/MD.0000000000012798.

A pilot study to standardize and peer-review shift handoffs in an academic internal medicine residency program: The DOCFISH method.

Author information

1
Chief Medicine Resident Quality and Patient Safety, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
2
Chief Neurology Resident Quality and Patient Safety, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
3
Hematology/Oncology Fellow, University of Florida, Gainesville, Florida.
4
Hematology/Oncology Fellow, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
5
Pulmonary/Critical Care Fellow, State University of New York (SUNY) Upstate Medical University, Syracuse, New York.
6
Assistant Professor of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA.

Abstract

With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine residency program. Compliance, resident/faculty perceptions, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention). Signouts were scored based on inclusion of seven elements: Daily events, Overnight events, Code status, Follow up tasks, If/then statements, 'sick or stable' and History present illness. The mnemonic 'DOCFISH' was taught in a grand-rounds forum then embedded into a shift-handoff tool within our electronic health record (EHR). Senior residents were assigned to supervise/provide feedback on shift handoffs from April-June 2016. Faculty and resident perceptions regarding quality of shift handoffs was measured by the annual ACGME (Accreditation Council Graduate Medical Education) program survey.Patient safety was measured by number of rapid-response teams (RRT) initiated for unstable vital signs. Handoffs were 74% complete in intervention group and 60% in control group (p < .0001). Median DOCFISH features present in patients that required RRT was 3 of 7 whereas, total post-intervention group had 5 of 7 (p < .001). 'Daily events' and 'follow -up tasks' were less frequent in patients that required RRT (20%, 67% respectively, p < .001).Academic medical centers can implement standardized shift handoffs by embedding high-yield information in an EHR with peer-review. Information during shift changes that may have significant improvement on patient safety includes: 'daily events' and 'follow -up tasks.'

PMID:
30313109
PMCID:
PMC6203497
DOI:
10.1097/MD.0000000000012798
[Indexed for MEDLINE]
Free PMC Article
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15.
Nurse Educ Pract. 2018 Nov;33:107-113. doi: 10.1016/j.nepr.2018.08.019. Epub 2018 Sep 5.

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.

Author information

1
School of Nursing & Midwifery, Edith Cowan University, 270Joondalup Drive, Joondalup, Western Australia, 6027, Australia. Electronic address: t.beament@ecu.edu.au.
2
School of Nursing & Midwifery, Edith Cowan University, 270Joondalup Drive, Joondalup, Western Australia, 6027, Australia. Electronic address: b.ewens@ecu.edu.au.
3
Centre for Nurse Education, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia. Electronic address: Sarah.wilcox@health.wa.gov.au.
4
Training & Development, Joondalup Health Campus, Shenton Avenue, Joondalup, WA, 6027, Australia. Electronic address: reidg@ramsayhealth.com.au.

Abstract

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.

PMID:
30273803
DOI:
10.1016/j.nepr.2018.08.019
[Indexed for MEDLINE]
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16.
Qual Manag Health Care. 2018 Oct/Dec;27(4):215-222. doi: 10.1097/QMH.0000000000000187.

A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room.

Author information

1
Departments of Anesthesiology & Perioperative Medicine (Drs Karamchandani and Carroll and Ms Prozesky) and Surgery (Drs Fitzgerald and Armen), Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; and Department of Quality Systems Improvement (Mss Trauger and Ciccocioppo) and Surgical Anesthesia Intensive Care Unit (Mr Hess), Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.

Abstract

OBJECTIVE:

Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern.

METHODS:

The current state of the patient transfer processes between the intensive care units (ICUs) and the operating rooms (ORs) was mapped and failure modes were identified. A multidisciplinary team was convened and a standardized handoff process and tool (checklist) was developed. Adherence to the process and care team satisfaction was assessed at the end of a 60-day pilot period.

RESULTS:

The process was successfully implemented hospital-wide covering all adult and pediatric ICUs. We observed a 90% compliance rate with ICU to the OR transfers and 95% compliance rate with transfers from OR to the ICU during the 60-day pilot period. The care team expressed overall satisfaction with the process and identified potential areas of improvement.

CONCLUSION:

A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety.

17.
J Contin Educ Nurs. 2018 Oct 1;49(10):460-466. doi: 10.3928/00220124-20180918-06.

Standardizing the Bedside Report to Promote Nurse Accountability and Work Effectiveness.

Abstract

BACKGROUND:

This study evaluated bedside reporting from the nurse's perspective regarding accountability, empowerment, work effectiveness, satisfaction, and communication. The aim was to examine the effects of an educational learning activity on bedside handoff reporting related to accountability and work effectiveness. The communication was used at change of shift between frontline nurses, with future interprofessional implementation.

METHOD:

A demographic questionnaire, the Specht and Ramler Accountability Index-Individual Referent and the Conditions for Workplace Effectiveness Questionnaire-II were administered pre-posteducational (learning activity) intervention. Of 184 RNs, 104 completed the pretest, with only 73 of those completing the posttest.

RESULTS:

Statistically significant differences were seen with empowerment, work effectiveness, communication, and nurse job satisfaction posttest; no statistically significant difference was found with accountability. The sample was ethnically diverse, with the majority being Latino pretest (n = 63, 55.8%) and posttest (n = 44, 60.3%).

CONCLUSION:

For medical-surgical units, incorporating bedside reporting can increase nurse satisfaction, accountability, and positive outcomes. J Contin Educ Nurs. 2018;49(10):460-466.

PMID:
30257029
DOI:
10.3928/00220124-20180918-06
[Indexed for MEDLINE]
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19.
J Clin Nurs. 2019 Jan;28(1-2):148-158. doi: 10.1111/jocn.14674. Epub 2018 Oct 5.

Changing from 12-hr to 8-hr day shifts: A qualitative exploration of effects on organising nursing care and staffing.

Author information

1
London South Bank University, London, UK.

Abstract

AIMS AND OBJECTIVES:

To investigate (a) How nursing care is organised on wards where nursing staff work different lengths of day shifts, and (b) How length of day shift affects the staffing of wards.

BACKGROUND:

Twelve-hour shifts have become increasingly common worldwide but there are concerns about impact on care quality and safety. Eight-hour shifts, and how day shift length affects how nurses organise their work, and staffing, have been little studied.

DESIGN:

Case study.

METHODS:

The setting was two older people's wards in an acute hospital in England. Nursing staff on one ward continued to work 12-hr day shifts; staff on the other ward worked 8 hr late and early day shifts, with an afternoon overlap, for 6 months. Qualitative interviews were conducted with 22 nursing staff. Semi-structured observations were conducted from 12-15.00 (5 × 3 hr episodes on each ward). Data analysis was conducted using the Framework approach.

RESULTS:

Theme 1: Organising nursing care and staff activities, (sub-themes: Care delivery across a 12 hr shift; Care delivery on early and late 8 hr shifts; Staff communication and documentation; Staff breaks; Teaching, supervision and staff development); Theme 2: Staffing wards with different length of day shift (sub-themes:: Adequacy of staffing and use of temporary staff; Recruitment and retention of staff after introducing 8 hr shifts).

CONCLUSION:

Nursing staff organised care on 8-hr shifts similarly to 12-hr shifts but then felt dissatisfied with their care delivery and handovers. Nursing staff on both wards approached care in a task-focused way. There were concerns that adopting an 8-hr shift pattern negatively affected recruitment and retention.

RELEVANCE TO CLINICAL PRACTICE:

Changing from 12 hr to 8 hr day shifts may affect nursing staff satisfaction with their care delivery and handovers, and have a negative effect on staffing wards.

KEYWORDS:

12-hr shift; 8-hr shift; communication; day shift; handover; hospital ward; nursing care; recruitment; retention; staffing

20.
J Clin Nurs. 2018 Sep 19. doi: 10.1111/jocn.14679. [Epub ahead of print]

Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review.

Author information

1
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
2
School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
3
Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
4
Centre for Quality and Patient Safety Research, Eastern Health Partnership, Box Hill, Victoria, Australia.

Abstract

AIM:

To examine nursing handover of vital signs during patient care transition from the emergency department (ED) to inpatient wards.

BACKGROUND:

Communication failures are a leading cause of patient harm making communication through clinical handover an international healthcare priority. The transition of care from ED to ward settings is informed by nursing handover. Vital sign abnormalities in the ED are associated with clinical deterioration following hospital admission. Understanding the role and perceived value of vital sign content in clinical handover is important for patient safety.

METHODS:

An integrative design was used. A search of electronic databases was undertaken using MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and SCOPUS. Identified records were screened to elicit further studies for inclusion. A comprehensive peer-review screening process was performed. Studies were included that described the surrounding issues of handover, vital signs, ED, transition of care and ward.

RESULTS:

Five studies were included in the final review, one specific to nursing and four specific to emergency medicine. Vital signs were perceived to be an important inclusion in clinical handover, and the communication of vital signs in handover was perceived to be indicators for patient safety and risk factors for future clinical deterioration. The ED environment had an influence on effective communication within handover.

CONCLUSIONS:

Vital signs were an important inclusion for clinical handover. Deficiencies in vital sign content were perceived to be risk factors for patient adverse events following hospital admission. The quality of vital sign information in clinical handover may be important for accurate decision-making.

RELEVANCE TO CLINICAL PRACTICE:

Vital signs are an important component of clinical handover and are perceived to be indicators for patient safety and risk of future adverse events.

KEYWORDS:

emergency department; literature review; nurse; nursing handover; transfer; vital signs

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