Investigating optimal handover practice: an evaluation of a new initiative from an acute medical setting

Aims\udTo independently evaluate and assess the potential benefits and\uddrawbacks of an innovative approach to the delivery of morning\udmedical handover, in an acute medical emergency assessment\udunit (EAU).\ud\udMethods\udA survey was conducted with junior and middle-grade doctors\udattending the handover (N=14).\udThree focus groups, with middle-grade doctors (n=5), junior\uddoctors (n=11) and senior nurses (n=3), were conducted to gain\udfurther insights into the views and experiences of attendees.\udInterviews with two medical consultants and two directors of\udpostgraduate medical education were conducted to gain insight\udinto the strategic training and management perspective.\udFocus groups and interviews were recorded, transcribed, and\udanalysed using thematic analysis. The timeframe was May–\udAugust 2014.\ud\udResults\udQuantitative survey data were analysed using SPSS,\udgenerating descriptive frequencies. 79% of respondents\udpreferred to discuss safety incidents verbally, 79% found it\udhelpful to learn about clinical guidelines and 50% regarded\udthe process as too long on most days.\udQualitative findings revealed that the handover was regarded\udas a crucial process for prioritising and managing patients and\udcommunicating critical information across a multidisciplinary\udteam. Including a nursing perspective was consistently viewed\udas particularly beneficial, owing to nurses’ detailed overview of\udpatients within the unit. Discussing audit results, care bundles\udand clinical reminders was viewed as well placed, owing to\udtheir concise nature. However, the danger of detracting from\udthe clinical handover by incorporating education and a lack\udof a consistent clear focus was highlighted. Detailed patient\udpresentations and theoretical discussions were considered to be\udmore suitable in an alternative setting, potentially during rounds\udand bedside teaching. Suggestions of utilising an electronic\udsystem, separating the night team handover from an EAU\udmorning meeting, and changing shift times were also discussed.\ud\udConclusions\udThe foremost principle of a handover is to ensure that there is\uda robust clinical handover of continuous patient care from the\udoutgoing to the incoming team. While there is the potential to\udaugment this process with unique educational elements, it is\udessential that the delivery and content are carefully managed\udand structured in a manner that does not detract from the\udprimary focus of a clinical handover and compromise clinical\uddecision making. The handover model may benefit from\udhaving a more consistent time-bound structure, allowing the\udteam to have a clear focus on managing and directing optimal\udpatient care, whilst providing relevant educational aspects that\udimprove patient safety and quality of care