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Yip JWC. A Discourse Study on Handover Communication Among Care Providers in a Residential Care Home for Persons with Intellectual Disabilities. HEALTH COMMUNICATION 2024; 39:216-228. [PMID: 36593224 DOI: 10.1080/10410236.2022.2163105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Abundant research has focused on handovers among nurses and/or doctors in hospitals; far less is known about handovers among care providers in non-clinical contexts, such as care homes for the elderly or the disabled. Focusing on handovers in a residential care home for persons with intellectual disabilities (RCHID), this study argues that handover communication in non-clinical settings is equally important. Ineffective handovers can lead to the deterioration of the residents' health conditions, chaotic situations and even injuries to both care providers and care recipients. Staff in RCHIDs rely heavily on handover communication to obtain information about the residents' needs and to offer appropriate care services. Combining discourse analysis with interactional sociolinguistics, this study analyzes written and spoken discourses involved in handover communication among care providers in a typical RCHID in Hong Kong to investigate what and how communicative functions were achieved through the participants' language use. The data were collected by convenience sampling, including handwritten notes and handover recordings of twelve sessions. Then a group interview of seven care providers was conducted to obtain supplementary data. Findings suggest that handover communication includes informational and interpersonal functions. While information delivery is the main purpose, care providers also establish relationships with one another through small talk about care home residents. The results suggest potential drawbacks of the handovers, including illegible notes, inconsistent information collection, and low interactivity. This study proposes a model that elucidates the correlation between discourse, handover communication and healthcare services, and suggests strategies to enhance such communication.
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Affiliation(s)
- Jesse W C Yip
- Department of Linguistics and Modern Language Studies, The Education University of Hong Kong
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2
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Kaplan HC, Timpson W, Meyers J, Schierholz E, Cohen H, Fry M, Zayack D, Soll RF, Morrow KA, Edwards EM. Shift-to-shift handoffs in the NICU: lessons learned from a large scale audit. J Perinatol 2023; 43:1468-1473. [PMID: 37452115 DOI: 10.1038/s41372-023-01724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Describe the frequency of best practice behaviors during NICU provider and nursing shift-to-shift handoffs and identify strengths and opportunities for improvement. STUDY DESIGN Observational study of handoff characteristics among 40 centers participating in a learning collaborative over a 10-month period. Data were gathered using a handoff audit tool that outlined best practices. Comparisons of behaviors between nurse-to-nurse and provider-to-provider handoffs were made where appropriate. RESULTS Overall, 946 audits of shift-to-shift handoffs were analyzed. While many behaviors were demonstrated reliably, differences between nurse-to-nurse vs provider-to-provider handoffs were noted. Families were present for 5.9% of handoffs and, among those who were present, 48.2% participated by contributing information, asking questions, and sharing goals. CONCLUSIONS Observation and measurement of handoff behaviors can be used to identify opportunities to improve handoff communication, family participation, and human factors that support handoff. Auditing handoffs is feasible and necessary to improve these critical transitions in infants' care.
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Affiliation(s)
- Heather C Kaplan
- Perinatal Institute, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Wendy Timpson
- Division of Neonatology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jeffrey Meyers
- Division of Neonatology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | - Roger F Soll
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA
| | | | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
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3
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Jaulin F, Lopes T, Martin F. Standardised handover process with checklist improves quality and safety of care in the postanaesthesia care unit: the Postanaesthesia Team Handover trial. Br J Anaesth 2021; 127:962-970. [PMID: 34364652 DOI: 10.1016/j.bja.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/19/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Miscommunication is a leading cause of preventable incidents in healthcare. A number of checklists have been created in an attempt to improve patient outcomes with only a small impact. However, the 2009 WHO Surgical Safety Checklist demonstrated benefits in terms of reduced morbidity and mortality. Our aim was to determine whether use of a Postanaesthesia Team Handover (PATH) checklist would reduce hypoxaemic events in the postanaesthesia care unit (PACU). METHODS This single-centre, prospective, pre-/post-implementation study was conducted between February 2019 and July 2020 in the PACU of Versailles Private Hospital, Paris, France. Pre-PATH implementation data were collected for 294 consecutive adult patients (≥18 yr old) admitted to the PACU and post-PATH implementation data were collected for 293 consecutive patients. The primary outcome was the rate of hypoxaemic events post-surgery during PACU stay. RESULTS The rates of hypoxaemic events were 4.1% (11/267 [95% confidence interval {CI}: 2.3-7.2%]) before the PATH checklist was introduced and 0.8% (2/266 [95% CI: 0.2-2.7%]) after. Patients in the PATH group were 5.6 times (odds ratio [OR] [95% CI: 1.3-33.6], P=0.041) less likely to have a hypoxaemic event than those in the control group. The handover process in the PATH checklist group also had significantly less interruptions (38.6% control vs 20.7% PATH; OR=2.5 [95% CI: 1.7-3.7]; P<0.0001). CONCLUSIONS Implementation of the PATH checklist in adult patients post-surgery was associated with a reduction in the rate of hypoxaemic events in the PACU. These findings support standardisation of the handover process with checklists following anaesthesia and surgery. CLINICAL TRIAL REGISTRATION NCT03972423.
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Affiliation(s)
- François Jaulin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France
| | - Thomas Lopes
- Versailles Private Hospital, Ramsay Santé, Paris, France
| | - Frederic Martin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France; Versailles Private Hospital, Ramsay Santé, Paris, France.
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Diskin C, Byrne D, Normand C, O'Neill MB. The early experience of doctors training in pediatrics: patient safety culture and the role and influence of the registrar. Ir J Med Sci 2021; 191:271-278. [PMID: 33576922 DOI: 10.1007/s11845-021-02520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postgraduate medical training incorporates education, both formal and informal, combined with clinical service. This study explored the early training experience of pediatricians in Ireland and its potential impact on patient safety. AIM We sought to identify factors that contribute to the patient safety experience of new entrant pediatric trainees. METHODS Trainees, or senior house officers (SHOs), in their first year of postgraduate training, participated in an interview conducted using a critical interview technique (CIT). They described an adverse event where the medical care delivered to the patient was not ideal. Thematic analysis identified themes that influenced the described event. RESULTS Thirteen trainees participated in the interviews. This study identified influences on the relationship between the SHO and patient safety, including the SHO themselves, teamwork and communication. Colleagues within the workplace, including consultants, registrars, and nurses, also affect this relationship. The registrar is described as a central figure holding an active role in clinical care in 11 of the 13 stories told. In the participants' experience, the registrar was the senior decision-maker, teacher, team builder, and communication intermediary within the teams' hierarchical structure. The registrars' previous clinical experience, communication style, along with their ability to supervise and provide feedback shaped the SHO experience. CONCLUSIONS Through a process designed to focus on exploring patient safety, it emerged that the registrar plays a crucial role in the working experience of their junior colleagues. The influence of the registrar needs to be recognized within clinical teams and by postgraduate training bodies.
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Affiliation(s)
- Catherine Diskin
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, D2, Ireland. .,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. .,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Michael B O'Neill
- Faculty of Paediatrics, Royal College of Physicians of Ireland, Dublin, Ireland.,Mayo University Hospital, Castlebar, Mayo, Ireland
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Mullen A, Harman K, Flanagan K, O'Brien B, Isobel S. Involving mental health consumers in nursing handover: A qualitative study of nursing views of the practice and its implementation. Int J Ment Health Nurs 2020; 29:1157-1167. [PMID: 32677320 DOI: 10.1111/inm.12756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/28/2020] [Accepted: 05/28/2020] [Indexed: 01/05/2023]
Abstract
Nursing handover occurs between shifts and is an important means of communication and information exchange around consumer care. The involvement of consumers in nursing handover, known as 'bedside handover', is well established within general health settings and promotes a patient-centred approach to care. Bedside handover represents an opportunity for mental health settings to consolidate recovery-oriented principles, albeit with some unique challenges in the way that involving consumers in nursing handover is implemented. This qualitative descriptive study explores the views of nursing staff and nursing managers about involving consumers in nursing handover and the process of implementation across five mental health inpatient units in Australia. The study took place in a local health district covering regional and rural areas of New South Wales that had issued a directive to implement bedside handover. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study. Six focus groups were held with nursing staff (n = 22), and eleven individual interviews were undertaken with nursing managers to explore their perceptions of bedside handover and its implications for nursing practice. The data were analysed using thematic analysis. Data from focus groups and interviews were analysed separately and then combined to generate three themes: (i) the mental health context is different; (ii) protecting consumer privacy and confidentiality; and (iii) it might make things worse. The findings provide insights into both the challenges, and the process of involving consumers in nursing handover within mental health settings and provides guidance for future implementation.
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Affiliation(s)
- Antony Mullen
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Katryna Harman
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Flanagan
- Gold Coast Hospital and Health Service, SouthPort, Queensland, Australia
| | - Beth O'Brien
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Isobel
- Faculty of Medicine and Health, School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
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Sule AA, Caputo D, Gohal J, Dascenzo D. Desirable Features of an Interdisciplinary Handoff. JMIR Nurs 2020; 3:e18914. [PMID: 34345786 PMCID: PMC8279443 DOI: 10.2196/18914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 11/13/2022] Open
Abstract
Failure of communication of critical information during handoffs is one of the leading causes of medical errors, resulting in serious, yet preventable, adverse events in hospitals across the United States. Recent studies have shown that a majority of these errors occur during patient handoffs, with notable communication gaps in interdisciplinary handoffs. We suggest some features that would improve the handoff usability and effectiveness for interdisciplinary medical and nursing teams while potentially improving patient safety.
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Affiliation(s)
- Anupam Ashutosh Sule
- Department of Internal Medicine St Joseph Mercy Oakland Pontiac, MI United States
| | - Dean Caputo
- Department of Nursing St Joseph Mercy Oakland Pontiac, MI United States
| | - Jaskaren Gohal
- Department of Internal Medicine St Joseph Mercy Oakland Pontiac, MI United States
| | - Doug Dascenzo
- Department of Nursing St Joseph Mercy Oakland Pontiac, MI United States
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Abstract
INTRODUCTION Verbal handover alone compromises patient safety, and supporting written documents significantly increases retention of information, with printed handover sheets being the best at avoiding data loss. The Royal College of Surgeons (RCS) has produced guidelines on safe handover practice, in which a minimum dataset is recommended for inclusion when handing over patients to incoming surgical teams, and studies have indicated better adherence to these guidelines when preprinted handover proformas are used. METHODS All surgical handover sessions were attended for a one-week period, and copies of handover sheets were taken. These were analyzed against RCS guidelines on the essential dataset for safe handover practice. A standardized handover sheet, developed in accordance with these guidelines and designed to encourage impartation of this minimum dataset, was then circulated among members of the surgical department and made readily available on wards. After a 6-week period, a postintervention audit was conducted using the same methods. RESULTS Striking differences were seen in the quality of information handed over preintervention and postintervention. The documentation of patient location increased significantly (56%-87%, P < 0.0001; 95% CI, 0.460-0.151), as did the documentation of important outstanding clinical tasks (45%-89%, P = 0.004; 95% CI, 0.439-0.089). Documentation of blood results increased (P < 0.0001; 95% CI, 0.523-0.226), and the proportion of patients for whom the occurrence of a senior review was documented increased from 28% (18) to 85% (45) (P < 0.0001; 95% CI, 0.717-0.419) CONCLUSIONS: The use of a structured, computer-generated handover proforma significantly improved compliance with RCS guidelines within the surgical department of our hospital, and we recommend its continued use among on-call surgical teams.
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Holt N, Crowe K, Lynagh D, Hutcheson Z. Is there a need for formal undergraduate patient handover training and could an educational workshop effectively provide this? A proof-of-concept study in a Scottish Medical School. BMJ Open 2020; 10:e034468. [PMID: 32051318 PMCID: PMC7045128 DOI: 10.1136/bmjopen-2019-034468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Poor communication between healthcare professionals is recognised as accounting for a significant proportion of adverse patient outcomes. In the UK, the General Medical Council emphasises effective handover (handoff) as an essential outcome for medical graduates. Despite this, a significant proportion of medical schools do not teach the skill. OBJECTIVES This study had two aims: (1) demonstrate a need for formal handover training through assessing the pre-existing knowledge, skills and attitudes of medical students and (2) study the effectiveness of a pilot educational handover workshop on improving confidence and competence in structured handover skills. DESIGN Students underwent an Objective Structured Clinical Examination style handover competency assessment before and after attending a handover workshop underpinned by educational theory. Participants also completed questionnaires before and after the workshop. The tool used to measure competency was developed through a modified Delphi process. SETTING Medical education departments within National Health Service (NHS) Lanarkshire hospitals. PARTICIPANTS Forty-two undergraduate medical students rotating through their medical and surgical placements within NHS Lanarkshire enrolled in the study. Forty-one students completed all aspects. MAIN OUTCOME MEASURES Paired questionnaires, preworkshop and postworkshop, ascertained prior teaching and confidence in handover skills. The questionnaires also elicited the student's views on the importance of handover and the potential effects on patient safety. The assessment tool measured competency over 12 domains. RESULTS Eighty-three per cent of participants reported no previous handover teaching. There was a significant improvement, p<0.0001, in confidence in delivering handovers after attending the workshop. Student performance in the handover competency assessment showed a significant improvement (p<0.05) in 10 out of the 12 measured handover competency domains. CONCLUSIONS A simple, robust and reproducible intervention, underpinned by medical education theory, can significantly improve competence and confidence in medical handover. Further research is required to assess long-term outcomes as student's transition from undergraduate to postgraduate training.
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Affiliation(s)
- Nicholas Holt
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Kirsty Crowe
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Daniel Lynagh
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
| | - Zoe Hutcheson
- Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
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Olasoji M, Cross W, Reed F, Wang W, Jacob S, Plummer V. Mental health nurses' attitudes towards consumer involvement in nursing handover pre and post an educational implementation. Int J Ment Health Nurs 2019; 28:1195-1205. [PMID: 31325221 DOI: 10.1111/inm.12631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery-focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses' attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single-group pre-post-test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016-2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi-media education handover package. We found that training had a significant influence on mental health nurses' attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well-planned education can influence nurses' attitudes about involving consumers in the nursing handover processes.
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Affiliation(s)
- Michael Olasoji
- Faculty of Health, Arts and Design Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University, Mount Helen, Victoria , Australia
| | - Fiona Reed
- Peninsula Health, Frankston, Victoria, Australia
| | - Wei Wang
- Peninsula Clinical School, Central Clinical School, Faculty Medicine Nursing Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Sini Jacob
- Peninsula Health, Frankston, Victoria, Australia.,School of Nursing and Midwifery Faculty Medicine Nursing Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Virginia Plummer
- Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School, Faculty Medicine Nursing Health Sciences, Monash University, Clayton, Victoria, Australia
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Thaeter L, Schröder H, Henze L, Butte J, Henn P, Rossaint R, Sopka S. Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany. BMJ Open 2018; 8:e021202. [PMID: 30209154 PMCID: PMC6144335 DOI: 10.1136/bmjopen-2017-021202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN A controlled educational research study. SETTING The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. PARTICIPANTS A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). OUTCOME MEASURES Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. RESULTS Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. CONCLUSION We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.
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Affiliation(s)
- Laura Thaeter
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Hanna Schröder
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lina Henze
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jennifer Butte
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Patrick Henn
- School of Medicine, University College Cork, Cork, Ireland
| | - Rolf Rossaint
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saša Sopka
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Slade D, Murray KA, Pun JKH, Eggins S. Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. J Nurs Manag 2018; 27:161-171. [DOI: 10.1111/jonm.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Diana Slade
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
| | - Kristen A. Murray
- Department of English; The Hong Kong Polytechnic University; Hong Kong SAR China
| | - Jack K. H. Pun
- Department of English; City University of Hong Kong; Hong Kong SAR China
| | - Suzanne Eggins
- School of Literature, Language and Linguistics, ANU College of Arts and Social Sciences; Australian National University; Canberra ACT Australia
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12
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Noble LM, Scott-Smith W, O'Neill B, Salisbury H. Consensus statement on an updated core communication curriculum for UK undergraduate medical education. PATIENT EDUCATION AND COUNSELING 2018; 101:1712-1719. [PMID: 29706382 DOI: 10.1016/j.pec.2018.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/21/2018] [Accepted: 04/21/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine. METHOD The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education. RESULTS The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed. CONCLUSION Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula. PRACTICE IMPLICATIONS The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources.
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Affiliation(s)
| | - Wesley Scott-Smith
- Division of Medical Education, Brighton & Sussex Medical School, Brighton, UK
| | | | - Helen Salisbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE, Mattick K, Rees C. New graduate doctors' preparedness for practice: a multistakeholder, multicentre narrative study. BMJ Open 2018; 8:e023146. [PMID: 30158236 PMCID: PMC6119440 DOI: 10.1136/bmjopen-2018-023146] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE While previous studies have begun to explore newly graduated junior doctors' preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders' conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors' preparedness (or unpreparedness) using innovative qualitative methods. DESIGN A multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries. SETTING Four UK settings: England, Northern Ireland, Scotland and Wales. PARTICIPANTS Eight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period. RESULTS We identified 2186 narratives across all participants (506 classified as 'prepared', 663 as 'unprepared', 951 as 'general'). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors' preparedness for the General Medical Council's (GMC) outcomes for graduates. Stakeholders' conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders' perceptions of medical graduates' preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not). CONCLUSION Our narrative findings highlight the complexities and nuances surrounding new medical graduates' preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates' preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.
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Affiliation(s)
- Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Gueishan, Taiwan
| | - Alison Bullock
- Cardiff University, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff, UK
| | - Gerard Gormley
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Narcie Kelly
- Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | | | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Charlotte Rees
- Monash University, Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Melbourne, Victoria, Australia
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Schröder H, Thaeter L, Henze L, Drachsler H, Rossaint R, Sopka S. [Patient handoffs in undergraduate medical education: A systematic analysis of training needs]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 135-136:89-97. [PMID: 30054174 DOI: 10.1016/j.zefq.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Insufficient handoffs lead to an increase in the risk of complications and malpractice, treatment delays, prolonged hospital stays, costs and patient complaints. The German Society for Anesthesiology and Intensive Care (DGAI) and the European Resuscitation Council (ERC) recommend the implementation of a communication procedure according to the SBAR concept. So far, there have been few curricular requirements in Germany regarding handoffs. METHODS As part of the EU-funded PATIENT project an online-based cross-sectional needs analysis was conducted in three countries. In Aachen, 237 medical students answered 45 items concerning handoffs in three sections: A: skills (relevance and self-assessment), B: clinical experience (agreement), C: curricula content (presence and relevance). Data was recorded using a Likert scale (0-7). RESULTS The students rated an adequate handoff performance as highly important (M=6.8; SD: ±0.6) and their own expertise as low (M=4.0; SD: ±1.3). A high training need was identified for writing discharge letters and performing accurate handoffs. The students were aware of the link between adequate handoffs and patient safety (M=6.5; SD: ±0.9). They considered standardized handoff procedures as an important curricular component (M=6.1; SD: ±1.1). From their point of view, the handling of medical errors is underrepresented in the curriculum (61.7 %). CONCLUSION A need for handoff training was revealed, especially regarding transfers and discharges. Accordingly, learning objectives were determined and training modules developed and integrated into the curriculum in Aachen.
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Affiliation(s)
- Hanna Schröder
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland; Aachener interdisziplinäres Trainingszentrum für medizinische Ausbildung (AIXTRA), Uniklinik RWTH Aachen, Aachen, Deutschland.
| | - Laura Thaeter
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland; Aachener interdisziplinäres Trainingszentrum für medizinische Ausbildung (AIXTRA), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Lina Henze
- Aachener interdisziplinäres Trainingszentrum für medizinische Ausbildung (AIXTRA), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Hendrik Drachsler
- Deutsches Institut für internationale pädagogische Forschung (DIPF), Frankfurt am Main, Deutschland; Welten Institute, Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, HeerlenNetherlands
| | - Rolf Rossaint
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Saša Sopka
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland; Aachener interdisziplinäres Trainingszentrum für medizinische Ausbildung (AIXTRA), Uniklinik RWTH Aachen, Aachen, Deutschland
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Olasoji M, Plummer V, Reed F, Jacob S, Shaw L, Shanti M, Cross W. Views of mental health consumers about being involved in nursing handover on acute inpatient units. Int J Ment Health Nurs 2018. [PMID: 28646504 DOI: 10.1111/inm.12361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The involvement of consumers in handover with nurses has been identified as reducing miscommunication and a reduction in adverse events in generalist nursing settings. Mental health (MH) care is complex, and handover practices need to fit with the philosophy of recovery-focussed practice. Recovery-focussed practice recognizes the person at the centre of care as an expert in their own treatment and decision-making. The aim of the present study was to explore the views of consumers with a mental illness, without prior involvement in nursing handover, about their need to be involved in nursing handover on an acute mental health inpatient unit. Using an exploratory descriptive, qualitative design (n = 11), participants who were receiving care in an acute inpatient unit were recruited using purposive convenience sampling. Data were collected using semistructured interviews and analysed using thematic analysis. Participants' diagnoses were schizophrenia (n = 6), bipolar affective disorder (n = 4), and depression (n = 1). Two themes emerged from the interviews: (i) behind closed doors; and (ii) being involved. Several subthemes were also identified. The first theme, behind closed doors, had two subthemes: (i) it is about us; and (ii) knowing their thoughts. The second theme had three subthemes: (i) clarifying issues; (ii) setting expectations; and (iii) when and how. Nursing handover on the acute inpatient unit offers a good opportunity for consumers to take an active role in the delivery of nursing care. There is a need to rethink the way nursing handover occurs to include consumers.
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Affiliation(s)
- Michael Olasoji
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.,Peninsula Health, Melbourne, Victoria, Australia
| | - Fiona Reed
- Peninsula Health, Melbourne, Victoria, Australia
| | - Sini Jacob
- Peninsula Health, Melbourne, Victoria, Australia
| | - Liam Shaw
- Peninsula Health, Melbourne, Victoria, Australia
| | | | - Wendy Cross
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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16
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Sirgo Rodríguez G, Chico Fernández M, Gordo Vidal F, García Arias M, Holanda Peña MS, Azcarate Ayerdi B, Bisbal Andrés E, Ferrándiz Sellés A, Lorente García PJ, García García M, Merino de Cos P, Allegue Gallego JM, García de Lorenzo Y Mateos A, Trenado Álvarez J, Rebollo Gómez P, Martín Delgado MC. Handover in Intensive Care. Med Intensiva 2018; 42:168-179. [PMID: 29426704 DOI: 10.1016/j.medin.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 01/12/2023]
Abstract
Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.
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Affiliation(s)
- G Sirgo Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, España
| | - M Chico Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Azcarate Ayerdi
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - A Ferrándiz Sellés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - P J Lorente García
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - M García García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J M Allegue Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, España
| | - P Rebollo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid.
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Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med 2017; 6:1-12. [PMID: 28224102 PMCID: PMC5295164 DOI: 10.5492/wjccm.v6.i1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.
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18
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Monrouxe LV, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, Mattick K. How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014. BMJ Open 2017; 7:e013656. [PMID: 28087554 PMCID: PMC5253586 DOI: 10.1136/bmjopen-2016-013656] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/09/2016] [Accepted: 12/02/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. DESIGN A rapid review of the literature (registration #CRD42013005305). DATA SOURCES Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures. DATA EXTRACTION At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013-2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes. RESULTS Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy. CONCLUSIONS Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors.
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Affiliation(s)
- Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | | | - Mala Mann
- Cardiff University Library Service, Cardiff, Wales, UK
| | - Zoe John
- School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Alison Bullock
- CUREMeDE, Cardiff University School of Social Sciences, Cardiff, Wales, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, Graduate School of Education, University of Exeter, Exeter, UK
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Blyth C, Bost N, Shiels S. Impact of an education session on clinical handover between medical shifts in an emergency department: A pilot study. Emerg Med Australas 2016; 29:336-341. [PMID: 28004506 DOI: 10.1111/1742-6723.12717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 10/20/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of a medical education session on the implementation of a new change of shift medical clinical handover format in an urban hospital ED. METHODS This pilot study used a pre- and post-intervention design. The intervention consisted of a 1 h education session to teach a new handover format, SBARM (Situation, Background, Assessment, Recommendation, Medication). Data were collected through observations of doctors performing clinical handover and individual interviews with participants. RESULTS The educational intervention led to an increased focus on checking medication charts, but had minimal effect on changing other aspects of clinical handover at doctors' change of shift times. Perceived increased time spent on handover using the new system was seen as a major barrier to the implementation of SBARM. The addition of 'M' to 'SBAR' heightened awareness of checking medication and fluid charts. CONCLUSION Time pressures need to be taken into consideration when introducing changes to current processes. Also, it is recommended that, in addition to ongoing education, senior clinicians are engaged during the planning and execution stages of changes to practice.
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Affiliation(s)
- Caroline Blyth
- Medical Education Unit, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Nerolie Bost
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Sue Shiels
- Medical Education Unit, Logan Hospital, Meadowbrook, Queensland, Australia
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20
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Royce CS, Atkins KM, Mendiola M, Ricciotti H. Teaching Patient Handoffs to Medical Students in Obstetrics and Gynecology: Simulation Curriculum and Assessment Tool. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10479. [PMID: 30984821 PMCID: PMC6440488 DOI: 10.15766/mep_2374-8265.10479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Patient handoffs, the communications required for the safe transfer of patient care, are known to be a common source of medical errors. Simulation exercises are effective techniques for teaching the procedures and patient interaction skills involved in a handoff. We developed a teaching tool that allows students to individually interact with a simulated patient, develop a treatment plan, and practice a handoff to another provider. METHODS The curriculum is a flexible instructional tool to teach patient handoffs in the context of a simulated obstetric emergency for learners at the clerkship through first-year obstetrics and gynecology resident levels. The curriculum secondarily teaches management of first-trimester bleeding with acute blood loss and can be adapted to allow advanced learners to practice obtaining informed consent. To evaluate this simulation for educational effectiveness, we developed a faculty observation assessment tool. RESULTS The simulation assessments for history taking, fund of knowledge, and interpersonal skills were predictive of subsequent clerkship clinical grades. Eighty percent of students agreed the exercise was realistic, 95% agreed it was relevant to the clinical curriculum, 90% agreed the simulation taught handoff skills, and 73% agreed the simulation increased confidence in handoff skills. Students uniformly found the curriculum to be relevant, realistic, and effective at teaching handoff skills. DISCUSSION Use of this curriculum has the potential to improve students' communication skills, handoff performance, and confidence during an obstetrics and gynecology clerkship. The assessment tool may allow early identification of students in need of improvement in communication skills.
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Affiliation(s)
- Celeste S. Royce
- Instructor, Department of Obstetrics, Gynecology and Reproductive Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
- Corresponding author:
| | - Katharyn Meredith Atkins
- Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Monica Mendiola
- Instructor, Department of Obstetrics, Gynecology and Reproductive Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Hope Ricciotti
- Associate Professor, Department of Obstetrics, Gynecology and Reproductive Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
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McQuillan A, Carthey J, Catchpole K, McCulloch P, Ridout DA, Goldman AP. Republished: creating a safe, reliable hospital at night handover: a case study in implementation science. Postgrad Med J 2016; 90:493-501. [PMID: 25140006 DOI: 10.1136/postgradmedj-2013-002146rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We developed protocols to handover patients from day to hospital at night (H@N) teams. SETTING NHS paediatric specialist hospital. METHOD We observed four handover protocols (baseline, Phases 1, 2 and 3) over 2 years. A mixed-method study (observation, interviews, task analysis, prospective risk assessment, document and case note review) explored the impact of different protocols on performance. INTERVENTION In Phase 1, a handover protocol was introduced to resolve problems with the baseline H@N handover. Following this intervention, two further revisions to the handover occurred, driven by staff feedback (Phases 2 and 3). RESULTS Variations in performance between handover protocols on three process measures, start time efficiency, total length of handover, and number of distractions and interruptions, were identified. Univariate regression analysis showed statistically significant differences between handover protocols on two surrogate outcome measures: number of flagging omissions and the number of out of hours deteriorations (p=0.04 for Phase 3 vs Phase 1 for both measures (CI 1.04 to 4.08; CI 1.03 to 4.33), and for Phase 3 vs Phase 2 (p=0.006 and p=0.001 (CI 1.22 to 5.15; CI 1.62 to 9.0)), respectively). The Phase 1 and 2 handover protocols were effective at identifying patients whose clinical condition warranted review overnight. Performance on both surrogate outcome measures, length of handover and distractions, deteriorated in Phase 3. CONCLUSIONS A carefully designed prioritisation process within the H@N handover can be effective at flagging acutely unwell patients. However, the protocol we introduced was unsustainable. In a complex healthcare system, sustainable implementation of new processes may be threatened by conflicting goals.
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Affiliation(s)
- Annette McQuillan
- Cardiothoracic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jane Carthey
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ken Catchpole
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Deborah A Ridout
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Allan P Goldman
- Cardiothoracic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Stojan J, Mullan P, Fitzgerald J, Lypson M, Christner J, Haftel H, Schiller J. Handover education improves skill and confidence. CLINICAL TEACHER 2015; 13:422-426. [DOI: 10.1111/tct.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jennifer Stojan
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Patricia Mullan
- Department of Medical Education; University of Michigan Medical School; Ann Arbor Michigan USA
| | - James Fitzgerald
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Monica Lypson
- Department of Medical Education; University of Michigan Medical School; Ann Arbor Michigan USA
| | | | - Hilary Haftel
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Jocelyn Schiller
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
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Manias E, Geddes F, Watson B, Jones D, Della P. Perspectives of clinical handover processes: a multi-site survey across different health professionals. J Clin Nurs 2015; 25:80-91. [PMID: 26415923 DOI: 10.1111/jocn.12986] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the perspectives of health professionals of different disciplines about clinical handover. BACKGROUND Ineffective handovers can cause major problems relating to the lack of delivery of appropriate care. DESIGN A prospective, cross-sectional design was conducted using a survey about clinical handover practices. METHODS Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The sample comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Australia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover; their perceived effectiveness of clinical handover; involvement of patients and family members; health professionals' ability to confirm understanding and to clarify clinical information; role modelling behaviour of health professionals; training needs; adverse events encountered and possibilities for improvements. RESULTS In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers. CONCLUSIONS Complex barriers impeded the conduct of effective handovers, including insufficient opportunities for training, lack of role modelling, and lack of confidence and understanding about handover processes. RELEVANCE TO CLINICAL PRACTICE Greater focus should be placed on creating opportunities for senior health professionals to act as role models. Sophisticated approaches should be implemented in training and education.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.,Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Fiona Geddes
- School of Nursing & Midwifery, Curtin University, Bentley, WA, Australia
| | - Bernadette Watson
- School of Psychology, The University of Queensland, Brisbane, Qld, Australia
| | - Dorothy Jones
- School of Nursing & Midwifery, Curtin University, Bentley, WA, Australia
| | - Phillip Della
- School of Nursing & Midwifery, Curtin University, Bentley, WA, Australia
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Johnson DP, Zimmerman K, Staples B, McGann KA, Frush K, Turner DA. Multicenter development, implementation, and patient safety impacts of a simulation-based module to teach handovers to pediatric residents. Hosp Pediatr 2015; 5:154-9. [PMID: 25732989 DOI: 10.1542/hpeds.2014-0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Teaching and evaluation of handovers are important requirements of graduate medical education (GME), but well-defined and effective methods have not been clearly established. Case-based computer simulations provide potential methods to teach, evaluate, and practice handovers. METHODS Case-based computer simulation modules were developed. In these modules, trainees care for a virtual patient in a time-lapsed session, followed by real-time synthesis and handover of the clinical information to a partner who uses this information to continue caring for the same patient in a simulated night scenario, with an observer tallying included handover components. The process culminates with evaluator feedback and structured handover education. Surveys were used before and after module implementation to allow the interns to rate the quality of handover provided and record rapid responses and transfers to the ICU. RESULTS Fifty-two pediatric and medicine/pediatric residents from 2 institutions participated in the modules. "Anticipatory guidance" elements of the handover were the most frequently excluded (missing at least 1 component in 77% of module handovers). There were no significant differences in the proportion of nights with rapid response calls (7.24% vs 12.79%, P=.052) or transfers to the ICU (7.76% vs 11.27%, P=.21) before and after module implementation. CONCLUSIONS Case-based, computer-simulation modules are an easily implemented and generalizable mechanism for handover education and assessment. Although significant improvements in patient safety outcomes were not seen as a result of the educational module alone, novel techniques of this nature may supplement handover bundles that have been demonstrated to improve patient safety.
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Affiliation(s)
- David P Johnson
- Department of Pediatrics, Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; and
| | - Kanecia Zimmerman
- Department of Pediatrics, and Division of Pediatric Critical Care, Duke Children's Hospital, Durham, North Carolina
| | | | | | | | - David A Turner
- Department of Pediatrics, and Division of Pediatric Critical Care, Duke Children's Hospital, Durham, North Carolina
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25
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Hynes H, Stoyanov S, Drachsler H, Maher B, Orrego C, Stieger L, Druener S, Sopka S, Schröder H, Henn P. Designing Learning Outcomes for Handoff Teaching of Medical Students Using Group Concept Mapping: Findings From a Multicountry European Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:988-94. [PMID: 25650826 DOI: 10.1097/acm.0000000000000642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To develop, by consultation with an expert group, agreed learning outcomes for the teaching of handoff to medical students using group concept mapping. METHOD In 2013, the authors used group concept mapping, a structured mixed-methods approach, applying both quantitative and qualitative measures to identify an expert group's common understanding about the learning outcomes for training medical students in handoff. Participants from four European countries generated and sorted ideas, then rated generated themes by importance and difficulty to achieve. The research team applied multidimensional scaling and hierarchical cluster analysis to analyze the themes. RESULTS Of 127 experts invited, 45 contributed to the brainstorming session. Twenty-two of the 45 (48%) completed pruning, sorting, and rating phases. They identified 10 themes with which to select learning outcomes and operationally define them to form a basis for a curriculum on handoff training. The themes "Being able to perform handoff accurately" and "Demonstrate proficiency in handoff in workplace" were rated as most important. "Demonstrate proficiency in handoff in simulation" and "Engage with colleagues, patients, and carers" were rated most difficult to achieve. CONCLUSIONS The study identified expert consensus for designing learning outcomes for handoff training for medical students. Those outcomes considered most important were among those considered most difficult to achieve. There is an urgent need to address the preparation of newly qualified doctors to be proficient in handoff at the point of graduation; otherwise, this is a latent error within health care systems. This is a first step in this process.
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Affiliation(s)
- Helen Hynes
- H. Hynes is a lecturer in clinical science and practice, School of Medicine, University College Cork, Cork, Ireland. S. Stoyanov is senior research fellow, Faculty of Psychology and Educational Sciences, Open Universiteit Nederland, Heerlen, The Netherlands. H. Drachsler is assistant professor of Technology-Enhanced Learning, Faculty of Psychology and Educational Sciences, Open Universiteit Nederland, Heerlen, The Netherlands. B. Maher is senior lecturer in medical education, School of Medicine, University College Cork, Cork, Ireland. C. Orrego is project director for patient safety and innovation, Avedis Donabedian Institute, Barcelona, Spain. L. Stieger is a researcher, Aachen Interdisciplinary Centre for Training in Medical Education (AIXTRA), Skills Lab of the Medical Faculty, RWTH Aachen University, Aachen, Germany. S. Druener is a researcher, Aachen Interdisciplinary Centre for Training in Medical Education (AIXTRA), Skills Lab of the Medical Faculty, RWTH Aachen University, Aachen, Germany. S. Sopka is a consultant in anesthesiology and emergency medicine and head, Aachen Interdisciplinary Centre for Training in Medical Education (AIXTRA), Medical Faculty, RWTH Aachen University, Aachen, Germany. H. Schröder is a second-year resident, Department of Anaesthesiology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, and researcher, Aachen Interdisciplinary Centre for Training in Medical Education (AIXTRA), Aachen, Germany. P. Henn is lecturer in medical education, School of Medicine, University College Cork, Cork, Ireland
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Fisher JD, Freeman K, Clarke A, Spurgeon P, Smyth M, Perkins GD, Sujan MA, Cooke MW. Patient safety in ambulance services: a scoping review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe role of ambulance services has changed dramatically over the last few decades with the introduction of paramedics able to provide life-saving interventions, thanks to sophisticated equipment and treatments available. The number of 999 calls continues to increase, with adverse events theoretically possible with each one. Most patient safety research is based on hospital data, but little is known concerning patient safety when using ambulance services, when things can be very different. There is an urgent need to characterise the evidence base for patient safety in NHS ambulance services.ObjectiveTo identify and map available evidence relating to patient safety when using ambulance services.DesignMixed-methods design including systematic review and review of ambulance service documentation, with areas for future research prioritised using a Delphi process.Setting and participantsAmbulance services, their staff and service users in UK.Data sourcesA wide range of data sources were explored. Multiple databases, reference lists from key papers and citations, Google and the NHS Confederation website were searched, and experts contacted to ensure that new data were included in the review. The databases MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, Emerald, Education Resources Information Center (ERIC), Applied Social Sciences Index and Abstracts, Social Services Abstracts, Sociological Abstracts, International Bibliography of the Social Sciences (IBSS), PsycINFO, PsycARTICLES, Health Management Information Consortium (HMIC), NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED),Health Technology Assessment, the FADE library, Current Awareness Service for Health (CASH), OpenDOAR (Directory of Open Access Repositories) and Open System for Information on Grey Literature in Europe (OpenSIGLE) and Zetoc (The British Library's Electronic Table of Contents) were searched from 1 January 1980 to 12 October 2011. Publicly available documents and issues identified by National Patient Safety Agency (NPSA), NHS Litigation Authority (NHSLA) and coroners’ reports were considered. Opinions and perceptions of senior managers, ambulance staff and service users were solicited.Review methodsData were extracted from annual reports using two-stage thematic analysis, data from quality accounts were collated with safety priorities tabulated and considered using thematic analysis, NPSA incident report data were collated and displayed comparatively using descriptive statistics, claims reported to NHSLA were analysed to identify number and cost of claims from mistakes and/or poor service, and summaries of coroners’ reports were assessed using thematic analysis to identify underlying safety issues. The depth of analysis is limited by the remit of a scoping exercise and availability of data.ResultsWe identified studies exploring different aspects of safety, which were of variable quality and with little evidence to support activities currently undertaken by ambulance services. Adequately powered studies are required to address issues of patient safety in this service, and it appeared that national priorities were what determined safety activities, rather than patient need. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology.ConclusionPatient safety needs to become a more prominent consideration for ambulance services, rather than operational pressures, including targets and driving the service. Development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care, particularly to a mobile workforce often isolated from colleagues, which requires a body of supportive evidence and an inherent critical evaluation culture. It is difficult to extrapolate findings of clinical studies undertaken in secondary care to ambulance service practice and current national guidelines often rely on consensus opinion regarding applicability to the pre-hospital environment. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne D Fisher
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Karoline Freeman
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Aileen Clarke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Peter Spurgeon
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Mike Smyth
- West Midlands Ambulance Service, Millennium Point, Waterfront Business Park, Brierley Hill, West Midlands, UK
| | - Gavin D Perkins
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | | | - Matthew W Cooke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
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Manias E, Geddes F, Watson B, Jones D, Della P. Communication failures during clinical handovers lead to a poor patient outcome: Lessons from a case report. SAGE Open Med Case Rep 2015; 3:2050313X15584859. [PMID: 27489689 PMCID: PMC4857297 DOI: 10.1177/2050313x15584859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/08/2015] [Indexed: 11/17/2022] Open
Abstract
In the emergency department, communication failures occur in clinical handover due to the urgent, changing and unpredictable nature of care provision. We present a case report of a female patient who was assaulted, and identify how various factors interacted to produce communication failures at multiple clinical handovers, leading to a poor patient outcome. Several handovers created many communication failures at diverse time points. The bedside medical handover produced misunderstandings during verbal exchange of information between emergency department consultants and junior doctors, and there was miscommunication involving plastic registrars. There was a failure in adequately informing the general practitioner and the patient relating to follow-up care after discharge. Deficiencies of communication occurred with conveying changes in an investigative report. Communication could be improved by dividing the conduct of handover in a quiet room and at the bedside, ensuring multiple sources of information are used and encouraging role-modelling behaviours for junior clinicians.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia; Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Fiona Geddes
- School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia
| | - Bernadette Watson
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Dorothy Jones
- School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia
| | - Phillip Della
- School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia
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Stojan JN, Schiller JH, Mullan P, Fitzgerald JT, Christner J, Ross PT, Middlemas S, Haftel H, Stansfield RB, Lypson ML. Medical school handoff education improves postgraduate trainee performance and confidence. MEDICAL TEACHER 2015; 37:281-288. [PMID: 25155969 DOI: 10.3109/0142159x.2014.947939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training. METHODS About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p<0.05. RESULTS About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p<0.05); they were also more confident in their handoff abilities (p<0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p<0.05). CONCLUSIONS This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.
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Ince-Cushman D, Rudkin T, Rosenberg E. Supervised near-peer clinical teaching in the ambulatory clinic: an exploratory study of family medicine residents' perspectives. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:8-13. [PMID: 25601040 PMCID: PMC4348229 DOI: 10.1007/s40037-015-0158-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Near-peer teaching is used extensively in hospital-based rotations but its use in ambulatory care is less well studied. The objective of this study was to verify the benefits of near-peer teaching found in other contexts and to explore the benefits and challenges of near-peer clinical supervision unique to primary care. A qualitative descriptive design using semi-structured interviews was chosen to accomplish this. A faculty preceptor supervised senior family medicine residents as they supervised a junior resident. We then elicited residents' perceptions of the experience. The study took place at a family medicine teaching unit in Canada. Six first-year and three second-year family medicine residents participated. Both junior and senior residents agreed that near-peer clinical supervision should be an option during family medicine residency training. The senior resident was perceived to benefit the most. Near-peer teaching was found to promote self-reflection and confidence in the supervising resident. Residents felt that observation by a faculty preceptor was required. In conclusion, the benefits of near-peer teaching previously described in hospital settings can be extended to ambulatory care training programmes. However, the perceived need for direct observation in a primary care context may make it more challenging to implement.
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Affiliation(s)
- Daniel Ince-Cushman
- Department of Family Medicine, McGill University, 5700, chemin de la Côte-des-Neiges, H3T 2A8 Montréal, QC Canada
| | - Teresa Rudkin
- Department of Family Medicine, McGill University, 5700, chemin de la Côte-des-Neiges, H3T 2A8 Montréal, QC Canada
| | - Ellen Rosenberg
- Department of Family Medicine, McGill University, St. Mary’s Hospital, 3830 Lacombe Avenue, H3T 1M5 Montréal, QC Canada
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Mukhopadhyay A, Leong BSH, Lua A, Aroos R, Wong JJ, Koh N, Goh N, See KC, Phua J, Kowitlawakul Y. Differences in the handover process and perception between nurses and residents in a critical care setting. J Clin Nurs 2014; 24:778-85. [PMID: 25421502 DOI: 10.1111/jocn.12707] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To identify the differences in practices and perceptions of handovers between nurses and residents in the critical care setting, so as to improve the quality of the process. BACKGROUND Critically ill patients with complex problems are ideal for the study of handovers. However, few handover studies have been conducted in intensive care units. DESIGN Descriptive study using questionnaires. METHODS We interviewed all nurses and residents involved in handovers of patients admitted to and discharged from a medical intensive care unit over a period of one month. Interviews were guided by a questionnaire and conducted between 24-48 hours of handovers. RESULTS Out of 672 eligible participants, 580 (290 nurses and 290 residents) agreed to participate in the study (86·3% response rate). Compared to residents, nurses received more training on handovers, covered issues specific to allied health specialties more frequently during handovers, and reviewed patients earlier after handovers. The perceived importance of the different components of handover varied significantly: donor residents, donor nurses, recipient residents and recipient nurses emphasised the overall management plan, case complexity, management plan over the next 48 hours and past medical history, including allergies, respectively. Satisfaction in the handover was related to pre-handover review of electronic medical records, handover training and clarity level in the management plan following the handover, with only the last factor remaining significant on multivariate analysis. CONCLUSIONS More nurses than residents received prior training in handovers. Nursing handovers were more inclusive of allied health specialties. The perceived importance of the components of handover varied. Greater clarity in management plans was associated with better satisfaction. RELEVANCE TO CLINICAL PRACTICE Deficiencies in the handover process (lack of prior training in handovers, not including allied health specialties and not reviewing electronic records before handover) were identified, thus providing opportunities for mutual learning between nurses and residents.
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Testa D, Emery S. Understanding the perceptions and experiences of Certified Registered Nurse Anaesthetists regarding handovers: a focus group study. Nurs Open 2014; 1:32-41. [PMID: 27708793 PMCID: PMC5047301 DOI: 10.1002/nop2.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/08/2014] [Accepted: 08/03/2014] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of this exploratory study was to gain further insight into the perceptions and experiences of Certified Registered Nurse Anaesthetists regarding intraoperative handovers of care. Background Handovers of care often result in adverse events in hospitalized patients and this risk is increased in the operating room setting where handovers occur frequently. Handovers between nurse anaesthetists, who provide the majority of anaesthesia in the United States today, is under‐researched. Design Focus groups with Certified Registered Nurse Anaesthetists. Methods Two groups of nurse anaesthetists were recruited to participate in focus groups exploring their perception and experiences with intraoperative handovers of care. Content analysis was used to construe meaning from the context of the interviews. The findings were interpreted and discussed in a framework of Relationship‐Based Care. Findings There were four main themes that emerged from the data: (1) characteristics of the setting are a threat to handover quality; (2) individual provider characteristics have an impact on handover quality; (3) The timing of the handover represents a threat to handover quality and (4) individual patient characteristics have an impact on handover quality. Conclusion The specific threats to safe handover of care between nurse anaesthetists were perceived to fall into four major themes; this provides information needed to strengthen the environment of care and to improve safety in handover of care in the operating suite.
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Affiliation(s)
- Denise Testa
- Boston College Nurse Anesthesia Program Boston Massachusetts 02467
| | - Susan Emery
- Boston College Nurse Anesthesia Program Boston Massachusetts 02467
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Pascoe H, Gill SD, Hughes A, McCall-White M. Clinical handover: An audit from Australia. Australas Med J 2014; 7:363-71. [PMID: 25324901 DOI: 10.4066/amj.2014.2060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Australian National Safety and Quality Health Service (NHQHS) Standards (the "Standards") provide external criteria for hospitals to assess their practices. Since the introduction of the Standards, no Australian hospital has published a report on how its handover practices compare to these Standards. AIMS To evaluate house medical officer (HMO) shift-to-shift handover practices against the Standards at a large regional hospital. METHOD All HMOs employed by Barwon Health were invited to participate in our qualitative and quantitative study by completing an online questionnaire and taking part in a focus group. RESULTS Of the 100 HMOs, 61 completed the questionnaire and 11 HMOs participated in focus groups. Questionnaire results revealed that HMOs were concerned about the quality of shift-to-shift handovers. Fifty-three per cent reported that current shift-to-shift handover practices could be putting patients at risk of adverse events. Ninety-eight per cent indicated that the handover processes could be improved. One hundred per cent of the HMOs stated that the quality of handover varies according to the doctors involved. In the focus groups, issues were raised about current handover structure, documentation, attendance, content, and training. CONCLUSION HMOs in the current study identified multiple deficiencies in handover practice with regard to structure, documentation, attendance, content, and training. The primary methods to improve handover include making it more structured and standardised, and to provide HMOs with handover training.
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Johnston MJ, King D, Arora S, Cooper K, Panda NA, Gosling R, Singh K, Sanders B, Cox B, Darzi A. Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis. J Eval Clin Pract 2014; 20:486-97. [PMID: 24902627 DOI: 10.1111/jep.12186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. METHODS Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. CONCLUSION Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.
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Affiliation(s)
- Maximilian J Johnston
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London, UK
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Starmer AJ, O'Toole JK, Rosenbluth G, Calaman S, Balmer D, West DC, Bale JF, Yu CE, Noble EL, Tse LL, Srivastava R, Landrigan CP, Sectish TC, Spector ND. Development, implementation, and dissemination of the I-PASS handoff curriculum: A multisite educational intervention to improve patient handoffs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:876-84. [PMID: 24871238 DOI: 10.1097/acm.0000000000000264] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patient handoffs are a key source of communication failures and adverse events in hospitals. Despite Accreditation Council for Graduate Medical Education requirements for residency training programs to provide formal handoff skills training and to monitor handoffs, well-established curricula and validated skills assessment tools are lacking. Developing a handoff curriculum is challenging because of the need for standardized processes and faculty development, cultural resistance to change, and diverse institution- and unit-level factors. In this article, the authors apply a logic model to describe the process they used from June 2010 to February 2014 to develop, implement, and disseminate an innovative, comprehensive handoff curriculum in pediatric residency training programs as a fundamental component of the multicenter Initiative for Innovation in Pediatric Education-Pediatric Research in Inpatient Settings Accelerating Safe Sign-outs (I-PASS) Study. They describe resources, activities, and outputs, and report preliminary learner outcomes using data from resident and faculty evaluations of the I-PASS Handoff Curriculum: 96% of residents and 97% of faculty agreed or strongly agreed that the curriculum promoted acquisition of relevant skills for patient care activities. They also share lessons learned that could be of value to others seeking to adopt a structured handoff curriculum or to develop large-scale curricular innovations that involve redesigning firmly established processes. These lessons include the importance of approaching curricular implementation as a transformational change effort, assembling a diverse team of junior and senior faculty to provide opportunities for mentoring and professional development, and linking the educational intervention with the direct measurement of patient outcomes.
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Affiliation(s)
- Amy J Starmer
- Dr. Starmer is staff physician and lecturer in pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts. She is also volunteer affiliate professor, Department of Pediatrics, Oregon Health and Science University (OHSU) and OHSU Doernbecher Children's Hospital, Portland, Oregon. Dr. O'Toole is assistant professor, Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Dr. Rosenbluth is associate professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California. Dr. Calaman is associate professor, Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania. Dr. Balmer is associate professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Dr. West is professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California. Dr. Bale is professor, Departments of Pediatrics and Neurology, University of Utah School of Medicine, Intermountain Healthcare, and Primary Children's Hospital, Salt Lake City, Utah. Dr. Yu is associate professor, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland. Ms. Noble is I-PASS Study research coordinator, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. Ms. Tse is I-PASS Study research assistant, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. Dr. Srivastava is associate professor, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, and Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah. Dr. Landrigan is as
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Sujan M, Spurgeon P, Inada-Kim M, Rudd M, Fitton L, Horniblow S, Cross S, Chessum P, W Cooke M. Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and objectivesHandover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover.MethodsThree NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways.ResultsHandover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows.ConclusionsThe research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | - Matthew Inada-Kim
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Michelle Rudd
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Larry Fitton
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Simon Horniblow
- United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK
| | - Steve Cross
- United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK
| | - Peter Chessum
- Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
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Sadideen H, Hamaoui K, Saadeddin M, Cogswell L, Goodacre T, Jefferis T. Handover practice amongst core surgical trainees at the Oxford School of Surgery. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2014; 11:3. [PMID: 24699448 PMCID: PMC4022973 DOI: 10.3352/jeehp.2014.11.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To date no studies have specifically evaluated the use of handovers amongst core surgical trainees (CSTs) in the United Kingdom. We examined handover practice at the Oxford School of Surgery to assess and improve CSTs'perception of handover use as well as its quality, and ultimately patient care. METHODS Based on guidelines published by the British Medical Association and Royal College of Surgeons, a 5-point Likert style questionnaire that collected data on handover practice, its educational value, and the CSTs'satisfaction with handover was given to 50 CSTs in 2010. RESULTS Forty CSTs (80.0%) responded to the questionnaire. The most striking findings revolved around the perceived educational value, formal training, and auditing practice of handovers throughout various units, which were all remarkably lower than expected. As a result, handover practice amongst CSTs was targeted and revised at the University Hospital's Department of Plastic Surgery, with the implementation of targeted changes to improve handover practice. CONCLUSION The execution of daily handovers was an underused educational tool amongst surveyed CSTs and may be an important modality to target, particularly in the competency-based, time-limited training CSTs receive. We recommend modifications to current practice based on our results and the literature and encourage the assessment of handover practice at other institutions.
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Affiliation(s)
- Hazim Sadideen
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Karim Hamaoui
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Munir Saadeddin
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Lucy Cogswell
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tim Goodacre
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tony Jefferis
- Department of Plastic and Reconstructive Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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McQuillan A, Carthey J, Catchpole K, McCulloch P, Ridout DA, Goldman AP. Creating a safe, reliable hospital at night handover: a case study in implementation science. BMJ Qual Saf 2013; 23:465-73. [DOI: 10.1136/bmjqs-2013-002146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Weiss MJ, Bhanji F, Fontela PS, Razack SI. A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer. MEDICAL EDUCATION 2013; 47:832-41. [PMID: 23837430 DOI: 10.1111/medu.12212] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/16/2012] [Accepted: 02/27/2013] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover. METHODS This study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression. RESULTS The intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p < 0.01). The intervention group had significantly higher clinical reasoning scores when compared by total score (21.1 versus 15.9 points; p = 0.01) and in each of the five domains. No difference was observed in the duration of handover between groups (7.4 versus 7.7 minutes; p = 0.97). CONCLUSIONS Using a novel scoring system, our simple handover cognitive aid was shown to improve information transfer and resident expression of clinical reasoning without prolonging the handover duration.
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Affiliation(s)
- Matthew J Weiss
- Division of Pediatric Critical Care, McGill University, Montréal, Québec, Canada.
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Blakey JD, Fearn A, Shaw DE. What drives the 'August effect'? A observational study of the effect of junior doctor changeover on out of hours work. JRSM SHORT REPORTS 2013; 4:2042533313489823. [PMID: 24040495 PMCID: PMC3767064 DOI: 10.1177/2042533313489823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To investigate whether measurements of junior doctor on-call workload and performance can clarify the mechanisms underlying the increase in morbidity and mortality seen after junior doctor changeover: the ‘August effect’. Design Quantitative retrospective observational study of routinely collected data on junior doctor workload. Setting Two large teaching hospitals in England. Participants Task level data from a wireless out of hours system (n = 29,885 requests) used by medical staff, nurses, and allied health professionals. Main outcome measures Number and type of tasks requested by nurses, time to completion of tasks by junior doctors. Results There was no overall change in the number of tasks requested by nurses out of hours around the August changeover (median requests per hour 15 before and 14 after, p = 0.46). However, the number of tasks classified as urgent was greater (p = 0.016) equating to five more urgent tasks per day. After changeover, doctors took less time to complete tasks overall due to a reduction in time taken for routine tasks (median 74 vs. 66 min; p = 3.9 × 10−9). Conclusion This study suggests that the ‘August effect’ is not due to new junior doctors completing tasks more slowly or having a greater workload. Further studies are required to investigate the causes of the increased number of urgent tasks seen, but likely factors are errors, omissions, and poor prioritization. Thus, improved training and quality control has the potential to address this increased duration of unresolved patient risk. The study also highlights the potential of newer technologies to facilitate quantitative study of clinical activity.
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Affiliation(s)
- John D Blakey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK ; Department of Respiratory Medicine, Aintree University Hospital, Liverpool, L9 7AL, UK
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Pezzolesi C, Manser T, Schifano F, Kostrzewski A, Pickles J, Harriet N, Warren I, Dhillon S. Human factors in clinical handover: development and testing of a 'handover performance tool' for doctors' shift handovers. Int J Qual Health Care 2012; 25:58-65. [PMID: 23220763 DOI: 10.1093/intqhc/mzs076] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. DESIGN The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. SETTING This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. PARTICIPANTS Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. MAIN OUTCOME MEASURES Item development, HPT validity and reliability. RESULTS The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). CONCLUSIONS Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practice.
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Affiliation(s)
- Cinzia Pezzolesi
- University of Hertfordshire, School of Pharmacy, Hillside House, College Lane Campus, Hatfield AL10 9BS, UK.
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Rosenthal C, Balzer F, Boemke W, Spies C. [Patient safety in anesthesiology and intensive care medicine. Measures for improvement]. Med Klin Intensivmed Notfmed 2012; 108:657-65. [PMID: 23128849 DOI: 10.1007/s00063-012-0182-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/08/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
Technical improvements as well as various strategies for error detection and error prevention have made intensive care medicine and anesthesiology a safe medical specialty. Due to the introduction of "Patient safety in the ICU: the Vienna declaration" of the European Society of Intensive Care Medicine (ESICM) from October 2009 and the "Helsinki declaration on patient safety" of the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology (EBA) from June 2010, there are now specific recommendations for all hospitals in Europe concerning the safety measures that are considered to be of essential importance. Many of today's well-known safety strategies have been originally developed in non-medical environments, as for instance civil aviation. Such high reliability organizations may serve as examples in the medical domain. Critical incident reporting systems, crisis resource management and checklists, e.g. the World Health Organization (WHO) checklist, are safety approaches of this kind. In addition to these, standardized drug labelling, hand disinfection, techniques for patient handover and simulation-based training have been exemplarily selected for this article as measures that can increase patient safety.
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Affiliation(s)
- C Rosenthal
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVK, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Howie A. Medical handovers: an improvement opportunity. Br J Hosp Med (Lond) 2012; 73:306-7. [DOI: 10.12968/hmed.2012.73.6.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ailsa Howie
- Scottish Patient Safety Programme Fellow Combined Assessment Unit Royal Infirmary Edinburgh Edinburgh EH16 4SA
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Hunt GE, Marsden R, O'Connor N. Clinical handover in acute psychiatric and community mental health settings. J Psychiatr Ment Health Nurs 2012; 19:310-8. [PMID: 22070444 DOI: 10.1111/j.1365-2850.2011.01793.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study collected an area-wide snapshot of current handover practice in psychiatric settings which included acute care units and community mental health centres. The study was conducted in two stages. Firstly, a questionnaire was sent to all clinical mental health staff within an area-wide health service regarding normal handover procedures and processes. The second part of the study used non-participant observers to evaluate actual handovers in inpatient and community settings. Of the 1125 surveys distributed in stage one, 380 (34%) were returned completed. Of the 40 handovers observed in stage two in which 637 patients were discussed, 40% included at least one consultant psychiatrist or registrar as a participant. Almost all the handovers were completed face-to-face in a specific location with a set time and duration. Eighty-six per cent of respondents reported that deteriorating patients were escalated for rapid response. The results of the survey and structured observations support the issues emerging from the literature from medical, surgical and clinical team handovers. Additionally, the issue of identifiers for deterioration of a psychiatric patient emerged as an area worthy of further investigation and incorporation into clinical handover education and training for psychiatric services.
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Affiliation(s)
- G E Hunt
- Discipline of Psychiatry, University of Sydney and Sydney Local Health Network, Concord Centre for Mental Health, Concord, NSW 2139, Australia.
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Bittner EA, George E, Eikermann M, Schmidt U. Evaluation of the association between quality of handover and length of stay in the post anaesthesia care unit: a pilot study. Anaesthesia 2012; 67:548-549. [PMID: 22493966 DOI: 10.1111/j.1365-2044.2012.07091.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Affiliation(s)
- E A Bittner
- Massachusetts General Hospital Boston, MA, USA
| | - E George
- Massachusetts General Hospital Boston, MA, USA
| | - M Eikermann
- Massachusetts General Hospital Boston, MA, USA
| | - U Schmidt
- Massachusetts General Hospital Boston, MA, USA
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DeRienzo CM, Frush K, Barfield ME, Gopwani PR, Griffith BC, Jiang X, Mehta AI, Papavassiliou P, Rialon KL, Stephany AM, Zhang T, Andolsek KM. Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:403-410. [PMID: 22361790 DOI: 10.1097/acm.0b013e318248e5c2] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.
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Affiliation(s)
- Christopher M DeRienzo
- Division of Neonatal-Perinatal Medicine, Duke University Hospital, Durham, North Carolina, USA.
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Aylward M, Vawter L, Roth C. An interactive handoff workshop to improve intern readiness in patient care transitions. J Grad Med Educ 2012; 4:68-71. [PMID: 23451310 PMCID: PMC3312537 DOI: 10.4300/jgme-d-11-00067.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/09/2011] [Accepted: 08/09/2011] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patient handoffs are common during residency and are often performed with little or no training. We devised a simple intervention to improve the readiness of interns to perform handoffs. METHODS We administered a 90-minute interactive workshop during intern orientation in 2009 and 2010. It consisted of a discussion, a case presentation, and a trigger video, followed by debriefing and a role-play exercise. The workshop required minimal technology and materials. Interns were surveyed on their readiness to perform handoffs before and after the workshop as well as 3 to 6 months after the workshop. RESULTS Eighty-nine interns participated in the workshop during a 2-year period. Seventy-four survey responses were collected. Self-reported readiness to perform a handoff increased by 26%. A total of 91% and 81% of respondents in 2010 and 2009, respectively, reported using aspects of the workshop up to 6 months later. CONCLUSION A brief workshop can improve interns' readiness to perform handoffs.
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Ahmed J, Mehmood S, Rehman S, Ilyas C, Khan L. Impact of a structured template and staff training on compliance and quality of clinical handover. Int J Surg 2012; 10:571-4. [DOI: 10.1016/j.ijsu.2012.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/11/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Blakey JD, Guy D, Simpson C, Fearn A, Cannaby S, Wilson P, Shaw D. Multimodal observational assessment of quality and productivity benefits from the implementation of wireless technology for out of hours working. BMJ Open 2012; 2:e000701. [PMID: 22466035 PMCID: PMC3317138 DOI: 10.1136/bmjopen-2011-000701] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction. DESIGN Prospective assessment using both quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports. SETTING A large teaching hospital in the UK. PARTICIPANTS Hospital at night co-ordinators, clinical support workers and junior doctors handling approximately 10 000 tasks requested out of hours per month. OUTCOME MEASURES Length of hospital stay, incidents reported, co-ordinator call logging activity, user satisfaction questionnaire, staff interviews. RESULTS Users were more satisfied with the new system (satisfaction score 62/90 vs 82/90, p=0.0080). With the new system over 70 h/week of co-ordinator time was released, and there were fewer untoward incidents related to handover and medical response (OR=0.30, p=0.02). Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system. CONCLUSIONS The introduction of call handling software and mobile technology over a medical-grade wireless network improved staff satisfaction with the Hospital at Night system. Improvements in efficiency and information flow have been accompanied by a reduction in untoward incidents, length of stay and peri-arrest calls.
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Affiliation(s)
- John D Blakey
- Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Debbie Guy
- City Hospital Campus, Nottingham NHS University Hospitals NHS Trust, Nottingham, UK
| | - Carl Simpson
- City Hospital Campus, Nottingham NHS University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Fearn
- City Hospital Campus, Nottingham NHS University Hospitals NHS Trust, Nottingham, UK
| | - Sharon Cannaby
- Health Sector Policy, Association of Chartered Certified Accountants, London, UK
| | - Petra Wilson
- European Health and Care Team, Internet Business Solutions Group, Cisco Systems, Brussels, Belgium
| | - Dominick Shaw
- Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, UK
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