Contents
Background: safety, quality and communication in clinical handover
Diana Slade, Suzanne Eggins, Fiona Geddes, Bernadette Watson, Elizabeth Manias, Jacqui Bear and Christy Pirone
1Effective communication in clinical handover: challenges and risks
1.2Communication in clinical handovers
1.3Recognizing the role of communication in clinical handover
1.4Impact of organizational and institutional factors
1.4.5Interdisciplinary boundaries
1.4.7Lack of clinical handover training
1.5Communicative risk factors in actual handover delivery
1.5.2Lack of adequate explanations about process
1.5.3Lack of patient involvement
1.5.4Excessive reliance on memory without reference to written documentation
1.5.5Poor quality of written medical records
1.6Responses designed to improve clinical handover communication
1.6.1Structural handover tools: ‘SBAR’
1.6.2Flexible standardization and the minimum dataset
1.6.3Patient-centered care and bedside handover
1.7Gaps in clinical handover research and understanding
1.7.1Lack of empirical evidence of actual communication in handover
1.7.2Under-theorization of patient-centered care
1.7.3Lack of evidence and evaluation of standardization
1.7.4Lack of clarity about ‘flexible standardization’ and the minimum dataset
1.7.5Unclear allocation of responsibility for behavioral change
1.8.2ECCHo as a mixed methods translational research project
1.8.4Translational research process
Fiona Geddes, Diana Slade, Suzanne Eggins, Bernadette Watson, Elizabeth Manias, Phillip Della and Dorothy Jones
2Clinicians’ voices: what healthcare professionals say about handover practice
2.2Investigating clinicians’ perspectives on clinical handover
2.3Adverse events associated with poor handover practice
2.4Issues and challenges in handover practices: the clinicians’ views
2.4.1Omission of significant information
2.4.2Changes and omissions in information across multiple shift-change handovers
2.4.3Lack of direct patient care by clinician handing over
2.4.4Lack of interaction in handovers
2.4.5Over-reliance on memory and lack of adequate written records
2.4.6Lack of mentoring of junior clinicians
2.5Clinicians’ responses to handover policy directions
2.5.1Clinicians’ use and evaluations of structured communication tools
2.5.2Adoption and perceived effectiveness of patient-centered handovers
2.6Clinicians’ suggestions to improve clinical handover
2.7The need for education and training in handover communication
Changing staff: clinical handovers at shift changes
Jeannette McGregor and Marian Lee
3Emergency department medical handovers as teaching and learning opportunities
3.1A morning round in the emergency department
3.2Factors at play during emergency department medical handovers
3.3Clinical handover during ward rounds in the emergency department – a view from the literature
3.4The theory of practice – another way to see the practice of clinical handover
3.5Our research site, aims and methods
3.6Challenges to effective handover in public hospital emergency departments
3.7Emergency department medical handover practice – doings, sayings and relatings
3.8Clinician perspectives on handover practice
Jeannette McGregor and Marian Lee
4Strengthening medical handover communication in emergency departments
4.2The unique features of the emergency department hospital environment
4.2.1The high demand for emergency department services
4.2.2The wide range of patients who visit emergency departments in Australian hospitals
4.2.4Most emergency department patients are undifferentiated
4.2.5Time and safety are closely connected in emergency departments
4.2.6Emergency departments are characterized by high levels of noise and constant interruptions
4.3The communication challenges of hospital emergency departments
4.3.2Challenges to building alliances between emergency department team members
4.3.3Poor access to clinical information
4.3.4Second language issues and poor health literacy
4.3.5Different grades of experience and applied knowledge
4.3.6Medical hierarchy of responsibility
4.4Five key principles of clinical handover practice
4.4.1Patient safety is at the center of clinical handover practice
4.4.2The transfer of responsibility and accountability is a core function of clinical handover
4.4.3Clinical handover is an organizational process
4.4.4Clinical handover depends on teamwork
4.4.5Clinical handover combines action, talk and relationships
4.5Five key principles of clinical handover communication
4.5.1Patient safety must be the focus of clinical handover communication
4.5.5.1Informational aspects of clinical handover
4.5.5.2Interpersonal aspects of clinical handover
4.6Communication strategies to strengthen clinical handover
4.6.1.1Prepare for clinical handover
4.6.1.3Use a consistent framework to transfer information
4.6.1.4Make sure the information framework is logical
4.6.1.5Use signposts to structure information at the sentence level
4.6.1.7Maximize the effectiveness of your information delivery
4.6.1.9Avoid using vague terms
4.6.1.10Provide your listeners with clear information distinctions
4.6.1.11Be aware that newcomers may not be familiar with medical terminology
4.6.2.1Establish rapport with team members
4.6.2.2Make it clear who is responsible for outstanding tasks
4.6.2.3Indicate to the speaker when you want to add information
4.6.2.4Indicate to the speaker when you want to confirm information or ask a question
4.6.2.5Ask the speaker to clarify or provide further information
4.6.2.6Find out information you do not know with WH-questions
4.6.2.7Explain why you are asking
4.6.2.8Confirm information with yes/no questions
4.6.2.9Clarify information with assumptive questions
Marian Lee and Jeannette McGregor
Suzanne Eggins and Diana Slade
6Communication in bedside nursing handovers
6.3Background: research questions and data
6.4Summary of interactional and information issues in bedside handovers
6.5Interactional issues in bedside handovers
6.6Informational issues in bedside handovers
6.6.2Redefining the ‘minimum dataset’
6.6.3Unstated assumptions: responsibility and accountability
6.7Conclusion: improving quality and safety in bedside handover
Suzanne Eggins and Diana Slade
7Resource: communicating effectively in bedside nursing handovers
7.2.1Dimensions of a good bedside handover
7.2.2Interactional dimensions of bedside handover: the CARE communication protocol
7.2.4Use of transcribed examples from actual handovers
7.2.5Information structure on ward sheets
7.3Conclusion: changing practice through targeted training
Changing sites: clinical handovers when patients move
Suzanne Eggins and Diana Slade
8Clinical handover in context: risks and protections across a hospital patient’s journey
8.3The paradox of clinical handover: a risk-minimizing and risk-creating event
8.4Clinical handover as a risk repair and educational resource
8.5Handover as a safety risk: poor and poor communication
8.6Summary of barriers to safe and effective handovers
8.6.1Attitudes to interactivity and assertiveness in the hospital context
8.6.3The persistence of an outdated attitude that excludes patients and carers from the handover
8.7Strategies to maximize the safety benefits of clinical handover
8.7.1Organizational strategies
8.7.3Mentoring and leadership strategies
Fiona Geddes, Phillip Della, Edward Stewart-Wynne and Dorothy Jones
9Interhospital transfer of rural patients: an audit of ‘patient expect’ documentation
9.2Background: research question, approach and data
9.2.1Research approach and sample
9.2.2iSoBAR for interhospital transfer and audit
9.2.3Qualities of the ‘patient expect’ call
9.3.3Determining clinical responsibility and accountability
9.3.4Diffusion of personal responsibility and accountability
9.3.5Delegation of responsibility and accountability
9.8Summary: expanding the concept of written clinical communication
Changing disciplines: clinical handovers in interprofessional teams
Fiona Geddes, Phillip Della, Edward Stewart-Wynne and Dorothy Jones
10.2Background: research question, approach and data collection
10.2.1Mnemonics and checklists
10.3Research site and approach
10.5.1Informational recommendations
10.5.2Interactional recommendations
Fiona Geddes, Edward Stewart-Wynne and Phillip Della
11Resource: interprofessional ward round handovers
11.1Better bedside communication
11.1.1For better bedside communication
11.2Informational structures: i-S-o-B-A-R
11.4Guidance on following the steps in the iSoBAR protocol
11.4.5A is for Agree to a Plan (Actions)
John Walsh, Nayia Cominos and Jon Jureidini
12Maintaining and generating knowledge in interprofessional mental health handovers
12.2Language and communication
12.3Successful teamwork communication: polite, respectful and inclusive
12.4Participation and turn-taking in meetings
12.5Preservative handover exchanges
12.6Generative handover exchanges
12.7Generative handover interactional strategies
12.7.7Elaboration, abstraction and integration
12.7.8Summary of generative communication strategies
John Walsh, Nayia Cominos and Jon Jureidini
13Patient voice: including the patient in mental health handovers
13.4The frequency of patient voice
13.6The function of patient voice in effective clinical handover
Christy Pirone, John Walsh and Nayia Cominos
14Resource: mental health clinical handover audit tool (mCHAT)
14.5Informational process and outcomes
14.6.1Team leader’s communication
14.6.2Team members’ communication
14.7Collating and reflecting on the audit results
Suzanne Eggins, Fiona Geddes and Diana Slade
15iCARE3: an integrated translational model of effective clinical handover communication
15.2Accumulating problems as systemic risks in clinical handover
15.3Interpreting risk: applying a systems approach to clinical handover
15.4Identifying types of communication risks in clinical handover
15.4.1Latent factors and active errors in clinical handover
15.5Managing communication risks: the iCARE3 model
15.6Contextual constraints in iCARE3: participants, scheduling, environment and resources
15.6.1Communicative context 1: Involving all relevant participants
15.6.2Communicative context 2: Scheduling
15.6.3Communicative context 3: Environment
15.6.4Communicative context 4: Resources
15.6.5Context and handover: summary
15.7Effective information is structured information: iSoBAR in iCARE3
15.7.1CARE-1 Information quality: Concise, Accurate, Reasoned, Explicit
15.8Handover as an interactive event: recipient design and iCARE3
15.8.1CARE-2 in spoken handovers: Connect, Ask, Respond, Empathize
15.8.2CARE-3 in written handovers: Compliant, Accessible, Readable, Enduring
15.9iCARE3 as a response to accumulating risks across the patient’s journey
15.10Clinical handover assessment and risk matrix (CHARM)
15.11.2Assessing contextual risks
15.11.3Assessing informational risks