Footnotes
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
Footnotes
| 1 | Where possible we use the terms ‘doctor’, ‘nurse’ or ‘allied health worker’ when it is clear from the context who we are talking about. At other times, this book uses the word ‘clinician’ to refer inclusively to doctors, nurses, social workers and all other healthcare practitioners working in hospitals. |
| 2 | In this book we refer to National Standard 6 as the Australian clinical handover standard. For details of the standard, see ACSQHC 2012b. For an overview of all the national healthcare standards, see ACSQHC 2012a. |
| 3 | Discourse analysis focuses on describing the structure and function of naturally occurring spoken or written language (see Eggins & Slade 1997). Discourses are enacted within a social context and in turn shape that social context. A detailed analysis of discourse is therefore a powerful technique for examining communication in practice. It enables systematic exploration of relations between clinicians as well as between clinician and patient, and of how information is exchanged and understood or misunderstood, and the consequence of these communication encounters to the patient health outcomes. |
| 4 | We would like to acknowledge Edward Stewart-Wynne and Annette Lenstra and the handover network for their contributions to the survey project as well as ECCHo team members Jeannette McGregor, Marian Lee, John Walsh, Jon Jureidini and Nayia Cominos for interview data. |
| 5 | For transcription conventions, see 3. |
| 6 | For transcription conventions, see page 3. |
| 7 | Methicillin-resistant Staphylococcus aureus (MRSA) is an infection caused by a strain of staph bacteria. It is resistant to the antibiotics commonly used to treat ordinary staph infections. |
| 8 | Pseudonyms are used in all transcripts and descriptions throughout the chapter. |
| 9 | For transcription conventions, see page 3. |
| 10 | ‘Sanjay’ turns out to be Doctor Sindarmana, the neurology registrar who examines this patient in Ward M during the morning. |
| 11 | Pseudonyms are used throughout the chapter. |
| 12 | All names are pseudonyms. |
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