Handover of patient care has been an ongoing problem within the health care sector. The process remains highly variable and there is a threat to patient safety. Despite the general belief that handover transitions in patient care have become routine, not enough attention or research has been directed at improving this period of care. For this reason there is a need to provide an analysis of the communication processes during handover. A study was conducted of the handover process among doctors during shift changes within a hospital setting. The results suggested a need for process change. Results revealed a handover process which was unstructured, informal and error prone, with the majority of doctors noting that there was no standard or formal procedure for handover. The research found that the majority of hospital doctors recognised the potential benefits of formalising and computerising this process.
Aust Health Rev 2005: 29(1): 68-79
MAINTAINING CONTINUITY BETWEEN WORK SHIFTS is important in all continuous process operations, especially in the health care sector. It is particularly crucial when one considers the continuity of care a hospitalised patient requires, which extends past a single doctor or team. A shift handover mechanism is needed to allow personnel changes with minimum disruption to the functioning of a ward or unit in a 24-hour work context. The goal of handover is the accurate and reliable communication of task-specific patient information across shift changes, thereby ensuring a relatively safe and effective continuous work environment.1 The motivation behind this research is to gain a better understanding of how handover operates and to identify recommendations to improve the process.
Handover in hospitals
In most hospitals, clinical records are still stored on paper.2 Medical staff keep track of current patients' conditions using hand-written charts. These charts are then either left at the patient's bed or at the service bench at each ward. The work of the Institute of Medicine has pointed out the inefficiencies in paper-based systems, such as loss of records and information, duplication of data, and incorrect data and storage, and highlights the need for more efficient information systems.3
Problems with the handover process are not new and have been reported in past studies, for example, McKenna.4 Miller descnbed the four main styles of the handover process: recorded, the bedside, written and verbal (traditional).5 Three recommendations were made for improvement: the need for regular reviews of the handover process, written guidelines for content of handover and the use of a pre-prepared handover sheet. McKenna and Walsh also reported on the need for better models to address the handover process.6 In a study by Roughton and Severs of junior doctor handover practices, it was found that existing handover processes did not meet doctors' expectations and there was a lack of advice and guidance on the structure of handover.7 The authors highlighted the opportunity to use information systems to help structure the process.
Handover is highly dynamic, relying heavily on interpersonal communication as an essential component of the process. A study conducted by Kerr showed handover in a paediatric hospital to be a very complex communication event, with a range of socially and technologically distributed practices and multiple functions.1 Kerr1 and Lardner 8 both identified handover in their studies as partitioned into three phases: pre-handover, an inter-shift meeting, and post-handover. Typically, handover occurs across varying levels of experience, knowledge, and roles. In addition, the nature of the communication may vary from chaotic, during periods of stress and multi-tasking, to organised and deliberate under controlled conditions. Beyond these immediate ambient factors, information transfer may also vary due to a lack of standardisation in the transition process and due to inherent difficulties with the degree of certainty attached to particular diagnoses. …