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
http://www.veryfunnyads.com/?oid=26095
•  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.
“ … 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.
 Behvioural Emergency Other
Health Dept 22%
Psych Unit 5% 5%
in Hospital
5% Loss of Death
Function 69%
Psych 9%
Hospital
12%
Hospital
Psych Hospital
Hospital Psych Unit in Hospital
73% Behvioural Health Med error
Emergency Dept 19% Wrong site
surg
29%

OP/post-op
25%
Wrong site surg
Suicide
27% Suicide
OP/post-op
Med error
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?
•  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
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”

•  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?)
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
 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
•  Participation
•  Observation
•  Filming
•  Reflexive Sessions
•  Implementation
•  Ongoing self-evaluation
• Lack of clinical ‘ownership’ of patient care
(nursing)
• Planning of care inadequately implemented
due to lack of interdisciplinary communication
• Dangers of discontinuity of care
• Nurse led (facilitated by senior medical staff)
handovers at ward round
• Improved continuity of care
• Educational opportunities
• Clinical team building
• Communication is prone to interruptions
• Out-dated information
• Time intensive >45mins

• Handover at the patients bedside led by the

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

•  Bedside patient check
•  Multi-disciplinary handover
•  Cross-hierarchy communication
•  Checklist support
•  Agreed interruption rules
•  Systematized documentation process
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.