Transcription conventions
by Elizabeth Manias, Bernadette Watson, Jacqui Bear, Marian Lee, Jeannette McGregor
Effective Communication in Clinical Handover
- Cover
- Title Page
- Copyright Page
- Preface
- Acknowledgements
- Contents
- Contributors
- Transcription conventions
- Section 1
- Background: safety, quality and communication in clinical handover
- 1 Effective communication in clinical handover: challenges and risks
- 1.1 Setting the scene
- 1.2 Communication in clinical handovers
- 1.3 Recognizing the role of communication in clinical handover
- 1.4 Impact of organizational and institutional factors
- 1.5 Communicative risk factors in actual handover delivery
- 1.6 Responses designed to improve clinical handover communication
- 1.7 Gaps in clinical handover research and understanding
- 1.7.1 Lack of empirical evidence of actual communication in handover
- 1.7.2 Under-theorization of patient-centered care
- 1.7.3 Lack of evidence and evaluation of standardization
- 1.7.4 Lack of clarity about ‘flexible standardization’ and the minimum dataset
- 1.7.5 Unclear allocation of responsibility for behavioral change
- 1.8 The ECCHo project: an interdisciplinary language-based approach to communication in clinical handover
- 1.9 Outline of this book
- 2 Clinicians’ voices: what healthcare professionals say about handover practice
- 2.1 Setting the scene
- 2.2 Investigating clinicians’ perspectives on clinical handover
- 2.3 Adverse events associated with poor handover practice
- 2.4 Issues and challenges in handover practices: the clinicians’ views
- 2.4.1 Omission of significant information
- 2.4.2 Changes and omissions in information across multiple shift-change handovers
- 2.4.3 Lack of direct patient care by clinician handing over
- 2.4.4 Lack of interaction in handovers
- 2.4.5 Over-reliance on memory and lack of adequate written records
- 2.4.6 Lack of mentoring of junior clinicians
- 2.5 Clinicians’ responses to handover policy directions
- 2.6 Clinicians’ suggestions to improve clinical handover
- 2.7 The need for education and training in handover communication
- 2.8 Conclusion
- 1 Effective communication in clinical handover: challenges and risks
- Section 2
- Changing staff: clinical handovers at shift changes
- 3 Emergency department medical handovers as teaching and learning opportunities
- 3.1 A morning round in the emergency department
- 3.2 Factors at play during emergency department medical handovers
- 3.3 Clinical handover during ward rounds in the emergency department – a view from the literature
- 3.4 The theory of practice – another way to see the practice of clinical handover
- 3.5 Our research site, aims and methods
- 3.6 Challenges to effective handover in public hospital emergency departments
- 3.7 Emergency department medical handover practice – doings, sayings and relatings
- 3.8 Clinician perspectives on handover practice
- 3.9 Discussion
- 3.10 Conclusion
- 4 Strengthening medical handover communication in emergency departments
- 4.1 Introduction
- 4.2 The unique features of the emergency department hospital environment
- 4.2.1 The high demand for emergency department services
- 4.2.2 The wide range of patients who visit emergency departments in Australian hospitals
- 4.2.3 The number of critical and acute unscheduled patients who present at Australian emergency departments
- 4.2.4 Most emergency department patients are undifferentiated
- 4.2.5 Time and safety are closely connected in emergency departments
- 4.2.6 Emergency departments are characterized by high levels of noise and constant interruptions
- 4.3 The communication challenges of hospital emergency departments
- 4.3.1 Episodic care
- 4.3.2 Challenges to building alliances between emergency department team members
- 4.3.3 Poor access to clinical information
- 4.3.4 Second language issues and poor health literacy
- 4.3.5 Different grades of experience and applied knowledge
- 4.3.6 Medical hierarchy of responsibility
- 4.3.7 High safety stakes
- 4.4 Five key principles of clinical handover practice
- 4.4.1 Patient safety is at the center of clinical handover practice
- 4.4.2 The transfer of responsibility and accountability is a core function of clinical handover
- 4.4.3 Clinical handover is an organizational process
- 4.4.4 Clinical handover depends on teamwork
- 4.4.5 Clinical handover combines action, talk and relationships
- 4.5 Five key principles of clinical handover communication
- 4.5.1 Patient safety must be the focus of clinical handover communication
- 4.5.2 The transfer of responsibility and accountability for ongoing patient care must be made explicit during clinical handover
- 4.5.3 Clinical handover participants must make team decisions about how each patient’s continuity of care is organized
- 4.5.4 Clinical handover participants must actively share and discuss patient information with other team members during handover
- 4.5.5 Clinical handover participants must negotiate both the informational and the interpersonal or interactional dimensions of clinical handover
- 4.6 Communication strategies to strengthen clinical handover
- 4.6.1 Informational communication strategies: how to facilitate the exchange of information during clinical handover
- 4.6.1.1 Prepare for clinical handover
- 4.6.1.2 Manage the context
- 4.6.1.3 Use a consistent framework to transfer information
- 4.6.1.4 Make sure the information framework is logical
- 4.6.1.5 Use signposts to structure information at the sentence level
- 4.6.1.6 Explain your reasoning
- 4.6.1.7 Maximize the effectiveness of your information delivery
- 4.6.1.8 Don’t assume knowledge
- 4.6.1.9 Avoid using vague terms
- 4.6.1.10 Provide your listeners with clear information distinctions
- 4.6.1.11 Be aware that newcomers may not be familiar with medical terminology
- 4.6.2 Interpersonal communication strategies: how to facilitate the relationship between speaker and listener during clinical handover
- 4.6.2.1 Establish rapport with team members
- 4.6.2.2 Make it clear who is responsible for outstanding tasks
- 4.6.2.3 Indicate to the speaker when you want to add information
- 4.6.2.4 Indicate to the speaker when you want to confirm information or ask a question
- 4.6.2.5 Ask the speaker to clarify or provide further information
- 4.6.2.6 Find out information you do not know with WH-questions
- 4.6.2.7 Explain why you are asking
- 4.6.2.8 Confirm information with yes/no questions
- 4.6.2.9 Clarify information with assumptive questions
- 4.6.1 Informational communication strategies: how to facilitate the exchange of information during clinical handover
- 4.7 Conclusion
- 5 Resource: transferring patient information to the emergency department medical team during clinical handover
- 6 Communication in bedside nursing handovers
- 6.1 Introduction
- 6.2 Setting the scene
- 6.3 Background: research questions and data
- 6.4 Summary of interactional and information issues in bedside handovers
- 6.5 Interactional issues in bedside handovers
- 6.6 Informational issues in bedside handovers
- 6.7 Conclusion: improving quality and safety in bedside handover
- 7 Resource: communicating effectively in bedside nursing handovers
- 3 Emergency department medical handovers as teaching and learning opportunities
- Section 3
- Changing sites: clinical handovers when patients move
- 8 Clinical handover in context: risks and protections across a hospital patient’s journey
- 8.1 Setting the scene
- 8.2 Good – but there are gaps
- 8.3 The paradox of clinical handover: a risk-minimizing and risk-creating event
- 8.4 Clinical handover as a risk repair and educational resource
- 8.5 Handover as a safety risk: poor and poor communication
- 8.6 Summary of barriers to safe and effective handovers
- 8.6.1 Attitudes to interactivity and assertiveness in the hospital context
- 8.6.2 Deference to role hierarchy or discipline boundaries, in particular junior with more senior doctors and nurses with doctors
- 8.6.3 The persistence of an outdated attitude that excludes patients and carers from the handover
- 8.6.4 Lack of confidence or skills in communicating in spontaneous, fast-paced, multi-party, patient-inclusive interactions
- 8.7 Strategies to maximize the safety benefits of clinical handover
- 8.8 Conclusion
- 9 Interhospital transfer of rural patients: an audit of ‘patient expect’ documentation
- 8 Clinical handover in context: risks and protections across a hospital patient’s journey
- Section 4
- Changing disciplines: clinical handovers in interprofessional teams
- 10 iSoBar: An innovative framework and checklist for clinical rounds in an interprofessional student training ward
- 11 Resource: interprofessional ward round handovers
- 12 Maintaining and generating knowledge in interprofessional mental health handovers
- 12.1 Introduction
- 12.2 Language and communication
- 12.3 Successful teamwork communication: polite, respectful and inclusive
- 12.4 Participation and turn-taking in meetings
- 12.5 Preservative handover exchanges
- 12.6 Generative handover exchanges
- 12.7 Generative handover interactional strategies
- 12.8 Conclusion
- 13 Patient voice: including the patient in mental health handovers
- 14 Resource: mental health clinical handover audit tool (mCHAT)
- Section 5
- Integrating ECCHo outcomes
- 15 iCARE3: an integrated translational model of effective clinical handover communication
- 15.1 Setting the scene
- 15.2 Accumulating problems as systemic risks in clinical handover
- 15.3 Interpreting risk: applying a systems approach to clinical handover
- 15.4 Identifying types of communication risks in clinical handover
- 15.5 Managing communication risks: the iCARE3 model
- 15.6 Contextual constraints in iCARE3: participants, scheduling, environment and resources
- 15.7 Effective information is structured information: iSoBAR in iCARE3
- 15.8 Handover as an interactive event: recipient design and iCARE3
- 15.9 iCARE3 as a response to accumulating risks across the patient’s journey
- 15.10 Clinical handover assessment and risk matrix (CHARM)
- 15.11 CHARM questions
- 15.12 Conclusion
- 15 iCARE3: an integrated translational model of effective clinical handover communication
- References
- Index
- Footnotes
Transcription conventions
(words in parentheses) indicate transcriber’s best guess
( ): empty parentheses indicate inaudible or untranscribable talk
[comments in square brackets]: relevant contextual information
[comments with question mark?]: transcriber’s contextual inference or guess
WORDS IN CAPS: speaker emphasis
Speakers’ false starts/re-starts are indicated by a long dash, e.g.
Nurse 2 Do you want me to – do you want me to run off the nursing list now?
Speaker hesitations are shown by an ellipsis, i.e. three dots …
Simultaneous/concurrent utterances: == before utterances indicates that the speakers spoke at the same time, e.g.
| 1 | Registrar 1 | ==No, it’s alright. |
| 2 | Junior doctor 2 | ==I’ve got the list? |
| 3 | Registrar 1 | Sorry? |
| 4 | Junior doctor 2 | I’ve got the nursing list here. |
This shows that Registrar 1 and Junior Doctor 2 both started their turns at the same time.
Overlapping utterances: == shows the point at which a second speaker starts talking during another speaker’s turn, e.g.
| 4 | Nurse 1 | I’ve got the nursing list here. Do you want me to – do you want me to run off the nursing list to see==if there’s anything more you want to say? |
| 5 | Nurse 2 | ==Sure, thanks. |
This shows that Nurse 2 started her turn when Nurse 1 was saying ‘if there’s’.
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