Investigating optimal handover practice: an evaluation of a new initiative from an acute medical setting

Kane, Ros and Thomson, Anna and Jackson, Christine and Allen-Collinson, Jacquelyn and Boardman, Shirine (2015) Investigating optimal handover practice: an evaluation of a new initiative from an acute medical setting. Future Hospital Journal, 2, (2, S3). ISSN 2055-3323

Full content URL: http://dx.doi.org/10.7861/futurehosp.2-2-s3

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Item Type:Article
Item Status:Live Archive

Abstract

Aims
To independently evaluate and assess the potential benefits and
drawbacks of an innovative approach to the delivery of morning
medical handover, in an acute medical emergency assessment
unit (EAU).

Methods
A survey was conducted with junior and middle-grade doctors
attending the handover (N=14).
Three focus groups, with middle-grade doctors (n=5), junior
doctors (n=11) and senior nurses (n=3), were conducted to gain
further insights into the views and experiences of attendees.
Interviews with two medical consultants and two directors of
postgraduate medical education were conducted to gain insight
into the strategic training and management perspective.
Focus groups and interviews were recorded, transcribed, and
analysed using thematic analysis. The timeframe was May–
August 2014.

Results
Quantitative survey data were analysed using SPSS,
generating descriptive frequencies. 79% of respondents
preferred to discuss safety incidents verbally, 79% found it
helpful to learn about clinical guidelines and 50% regarded
the process as too long on most days.
Qualitative findings revealed that the handover was regarded
as a crucial process for prioritising and managing patients and
communicating critical information across a multidisciplinary
team. Including a nursing perspective was consistently viewed
as particularly beneficial, owing to nurses’ detailed overview of
patients within the unit. Discussing audit results, care bundles
and clinical reminders was viewed as well placed, owing to
their concise nature. However, the danger of detracting from
the clinical handover by incorporating education and a lack
of a consistent clear focus was highlighted. Detailed patient
presentations and theoretical discussions were considered to be
more suitable in an alternative setting, potentially during rounds
and bedside teaching. Suggestions of utilising an electronic
system, separating the night team handover from an EAU
morning meeting, and changing shift times were also discussed.

Conclusions
The foremost principle of a handover is to ensure that there is
a robust clinical handover of continuous patient care from the
outgoing to the incoming team. While there is the potential to
augment this process with unique educational elements, it is
essential that the delivery and content are carefully managed
and structured in a manner that does not detract from the
primary focus of a clinical handover and compromise clinical
decision making. The handover model may benefit from
having a more consistent time-bound structure, allowing the
team to have a clear focus on managing and directing optimal
patient care, whilst providing relevant educational aspects that
improve patient safety and quality of care.

Keywords:Medical handover, Acute care, Future hospitals, Medical education, Safety, bmjgoldcheck, NotOAChecked
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
Divisions:College of Social Science > School of Health & Social Care
ID Code:17561
Deposited On:02 Jun 2015 13:26

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