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This document discusses improving handovers between shifts in intensive care units. It provides context on the HELiCS research project that examined handovers at four hospital sites. Effective handovers require understanding clinical roles and expertise, synthesizing patient information, and standardizing processes. Challenges include variable locations, participants, and information needs. The document advocates for content and topic standardization, as well as performance standardization through participation, observation, reflection and ongoing evaluation. Case studies demonstrate improved outcomes through multidisciplinary bedside handovers and use of checklists.

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239 views24 pages

ANZSIC Presentation 1 7

This document discusses improving handovers between shifts in intensive care units. It provides context on the HELiCS research project that examined handovers at four hospital sites. Effective handovers require understanding clinical roles and expertise, synthesizing patient information, and standardizing processes. Challenges include variable locations, participants, and information needs. The document advocates for content and topic standardization, as well as performance standardization through participation, observation, reflection and ongoing evaluation. Case studies demonstrate improved outcomes through multidisciplinary bedside handovers and use of checklists.

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CHC_UTS
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© Attribution Non-Commercial (BY-NC)
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Sustaining Handover

Improvement
Professor Rick Iedema Director of the Centre for Health
Communication, UTS

Dr Robert Herkes, Director of Intensive Care Services RPA


Sydney

Eamon Merrick RN MHSM, Research Fellow

Centre for Health Communication, University of Technology


Sydney

Royal Prince Alfred Hospital Intensive Care Services, Sydney


South West Area Health Service
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Handover & Safety Workshop

• Objectives: participants will be able to:


– See, as a fly on the wall, how handovers are conducted in
intensive care.
– Discuss the function of handover in maintaining continuity of
patient care.
– Reflect on the challenges that confront attempts to improve
handover.
– Plan strategies for the improvement of handovers.
Data for this workshop is
derived from

HELiCS: Handover Enabling Learning in Communication for


Safety.
Research contributing to the Australian Commission on Quality and
Safety in Healthcare, the National Clinical Handover Initiative: 2007-
20081

Examining Organisational Complexity, Risk, and the Built


Environment.
An Australian Research Council Discovery project: 2008-20112
Clinical Handover is …

“ … the transfer of professional responsibility and


accountability for some or all aspects of care for a patient, or
group of patients, to another person or professional group on a
temporary or permanent basis”3.

“… to provide accurate information about a [patients] care,


treatment, services, current condition and any recent or
anticipated changes….. The information communication during
handoff must be accurate in order to meet [patient] safety
goals”4.
Why Handover Matters5…
A Little Exercise…
Handover & Continuity

In your groups discuss the challenges inherent in maintaining


accurate handover:

•People involved in handover


•skill levels, expertise, professional types
•The types of information required by participants?
•Where, who synthesizes this information?
•Where, what, a potential sources of error?
•How would improve these situations?
Handover & process
complexity

Clinical risk is heightened by6:

• Interrupted communication and memory processes,


• multiple concurrent tasks and multi-tasking,
• Iintensified & fragmented communication,
• Iincreased segmentation of information (due to
specialisation).
Approaches to Improving
Handover7

• Content standardisation
– Listing of specific information that should always be mentioned in a
handover
• Topic standardisation
– Specification of general topic areas that should be covered in handover
• Performance standardisation
– The process that work groups develop/deployed for the ongoing
evaluation of handover performance
Topic Standardisation
Performance Standardisation

What makes handover effective?

•Understanding levels of clinical expertise


•Understanding clinical roles
•Understanding (intuitively) team dynamics
•Skill mix
•Organisational dynamics
•Service dynamics
•Understanding & synthesizing clinical need

“We must be alert to all the functions of handoff activity”


Confounding Factors8,9

• Level of care uncertainty


• (Non) standard time(s) for handover
• (Variable) location where handover is conducted
• (Different) participants in the handover (mono- vs
multi-disciplinary interaction)
• (Different) informational needs of participants
• (Changing) length of time devoted to handover
• Spatial organisations and arrangements (where is
handover conducted?)
A Little Exercise…

In your groups identify:

Where handover occurs.

What about?
Multidisciplinary communications
Patient/ family involvement
Educational functions
Professional development
Supervision

Plan how you would improve these handovers.


Clips
Contextual Solutions

Content Standardisation

• Prescriptive Guides
• Role specification during handover
• Ongoing review, mentoring, and supervision (formal/informal)
• Creating space for different modalities of communication
• Environmental arrangements/ location of handover
• Situational Guides (ESBAR, MIST, FASTHUG)
• Supporting multi-disciplinary communication (behavioural change)

Topic Standardisation
HELiCS

Approaching handover improvement through


performance standardisation.

• Participation
• Observation
• Filming
• Reflexive Sessions
• Implementation
• Ongoing self-evaluation
Multi-disciplinary Handover

Problems •Lack of clinical ‘ownership’ of patient care


Identified (nursing)
•Planning of care inadequately implemented due
to lack of interdisciplinary communication
•Dangers of discontinuity of care
Intervention •Nurse led (facilitated by senior medical staff)
handovers at ward round

Outcomes •Improved continuity of care


•Educational opportunities
•Clinical team building
Medical Handover

Problems •Communication is prone to interruptions


Identified •Out-dated information
•Time intensive >45mins

Intervention •Handover at the patients bedside led by the


senior registrar
Outcomes •Visual verification of information
•Precise
•Concise
•Professional format
•Time reduced <15-30, mins
Outcomes, Organisational
Culture

•Opportunities for dialogic education


•Coordination between disciplines
•Availability of contemporaneous information
•Early insight into emerging, potential, or previously unrecognised
problems
•Opportunity for the negotiation of supervisory support

“We must be alert to all the functions of handoff activity”


HELiCS: lessons learned from
four sites intervening in
handover
• Bedside patient check
• Multi-disciplinary handover
• Cross-hierarchy communication
• Checklist support
• Agreed interruption rules
• Systematized documentation process
www.communicationsafety.org
References

Coiera, E., Jayasuriya, R. A., Hardy, J., Bannan, A., & Thorpe, E. C. (2002). Communication loads on
clinical staff in the emergency department. Medical Journal of Australia, 176, 415-176.

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