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Aim: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. Design: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. Methods: We implemented a tailored ward‐based intervention to redesign nursing handover practice with co‐constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre‐implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio‐recorded handover events (n = 233). Post‐intervention we conducted interviews and focus groups (n = 79) and observed and/or audio‐recorded handover events (n = 129) to qualitatively evaluate impact. Results: Our translational approach resulted in substantial changes post‐intervention. Nurses conducted more shift‐to‐shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. Conclusion: Contextualised training combined with changes to ward‐level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward‐level leadership, collaboration and mentoring. The speed and degree of change post‐intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. Relevance to Clinical Practice: Nurses are more likely to conduct efficient group handovers and informative, patient‐centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward‐level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. Reporting Method: We adhered to the COREQ guidelines. Patient or Public Contribution: We interviewed patients on study wards pre and post intervention. [ABSTRACT FROM AUTHOR]

This paper describes clinicians’ views on the structure and content of an electronic discharge summary (EDS). A sample EDS template was developed by building on existing Australian guidelines to illustrate some of the proposed elements required for a high-quality clinical document. Surveys were widely disseminated to gather feedback and perspectives of hospital and primary care clinicians. A pragmatic approach to this study was underpinned by a strong evidence base and informed by implementation science methods. Key themes were identified, including variability in workflow and clinical needs, digital maturity, and digital health literacy of the clinical workforce. Understanding different workflows and priorities between hospital and primary care clinicians was a significant barrier to implementing a high-quality EDS. The strong consensus for change from both hospital and primary care clinicians, however, signaled the workforce's readiness as a potential enabler of high-quality EDS documentation. [ABSTRACT FROM AUTHOR]

Background: Clinical handover is an essential step in the surgical patient's hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team. Methods: We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed "Cardiothoracic Clinical Handover Tool" based on the Royal College of Surgeons of England's guidelines for "Safe Handover". Results: Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4 seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7 seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1). Conclusions: Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines. [ABSTRACT FROM AUTHOR]

This article discusses the importance of safe medication management during transitions of care from the hospital to other healthcare settings. It highlights the underuse of medication management reviews and the lack of resources for post-discharge reviews. The article also addresses challenges in accessing timely medications and the lack of clear responsibility and accountability for medication continuity and safety. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recommended various initiatives to improve medication management, but progress has been mixed. The article suggests implementing a transitions-of-care medication stewardship program to improve coordination, accountability, and education in medication management during care transitions. The ACSQHC is leading the development of a stewardship framework for medication management at transitions of care. The text emphasizes the need for accurate medication reconciliation, provision of necessary medications, and collaborative multidisciplinary medication management reviews and case conferencing for high-risk and complex patients. It suggests various strategies and interventions to achieve safe medication management, such as interim medication administration charts, patient and carer counseling, and adherence strategies. The text acknowledges the Australian Commission on Safety and Quality in Health Care for funding research on medication management at transitions of care. [Extracted from the article]

Abstract Background Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. Methods A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses’ education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken. Discussion If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.

BACKGROUND: Good communication is necessary for safety and quality of health. This study aims to determine the effect of ISBAR communication on nurses' perception of communication and attitudes toward patient safety in the Emirates Maternity Hospital in the Gaza Strip, Palestine METHOD: A single-group hospital-based intervention study (pre and posttest) was conducted. A census sample was used. Participants opinions about the effect of ISBAR were gathered using two tools established by Shortell, Rousseau, Sexton, and Helmreich to assess the communication awareness and nurses' attitudes towards safety, respectively, before and after the use of the ISBAR program. RESULTS: After the ISBAR application, nurses' perception of communication demonstrated a positive and significant increase in the three sub-items (openness, accuracy and understanding, and shift communication) in the nurse-nurse communication. Moreover, in four sub-items (openness, accuracy, and understanding, timeliness, and satisfaction) in nurse-doctor communication, (p = 0.05). Further, the nurses' attitudes toward patient safety showed a significant and positive increase in teamwork climate (p=0.001), safety climate (p = 0.007), job satisfaction and working condition (p=0.001), stress recognition (p = 0.008), and perception of management (p = 0.001). CONCLUSION: The results provide significant evidence of the positive effects of the ISBAR program in improving nurses' perceptions of communication and attitudes toward patient safety. It is recommended that healthcare providers use ISBAR communication in their practice. Moreover, periodic training programs are required for effective ISBAR communication among the healthcare team. [ABSTRACT FROM AUTHOR]

Background: Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. Methods: A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses' and medical officers' perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken. Discussion: If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally. Trial registration: Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022. [ABSTRACT FROM AUTHOR]

Objectives: To explore general practitioners' perspectives on the discharge summaries they receive about their patients who have been discharged from hospital. Methods: A survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content. Results: A total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated. Conclusions: General practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care. What is known about the topic? Discharge summaries are an important handover document when transitioning care from hospital to general practice. Delays, omissions and inaccuracies in discharge summaries can contribute to adverse patient outcomes. What does this paper add? This paper provides contemporary perspectives of general practitioners about discharge summaries and scope for improvements. What are the implications for practitioners? General practitioners value receiving discharge summaries that are timely, follow a format, provide clear details for ongoing care, and are an appropriate length. [ABSTRACT FROM AUTHOR]

Introduction: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. Methods: MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. Results: A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. Conclusion: The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive. [ABSTRACT FROM AUTHOR]

Introduction: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. Methods: MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. Results: A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. Conclusion: The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.

Objective: The objective of the study was to evaluate the effect of two self‐designed structured clinical tools on overall self‐perceptions of confidence in the assessment, management and communication of acutely unwell residents in nursing and care staff of residential aged care facilities (RACFs). Methods: Quasi‐experimental pre‐post design using surveys in 22 RACFs in Metropolitan Sydney, Australia. A convenience sample of 254 nursing and care staff were recruited. Two structured tools were developed to enhance confidence: (1) RACF Emergency Decision Index (REDI) and (2) Clinical Handover Assessment Tool (CHAT). The REDI is a clinical decision guide for treatment implementation and escalation, and the CHAT is a structured communication aid. Surveys were administered to participating nursing and care staff working within the RACFs prior to the implementation of the two structured tools (T0) and 6 months later (T1). Results: There was a significant increase in reported overall confidence in assessing and managing acutely unwell residents 6 months after the implementation of the REDI and CHAT (p = 0.003 and p = 0.006, respectively). Baseline Confidence in Assessment Scale and Confidence in Management Scale scores differed significantly 6 months following the implementation of the REDI and CHAT tools (p < 0.001). There was improvement across all surveyed communication domains. Conclusions: Preliminary data suggested that the two structured tools are effective in increasing confidence in the assessment, management and communication of acutely unwell residents for nursing and care staff working in RACFs. [ABSTRACT FROM AUTHOR]

Abstract Background A clinical handover is an essential nursing practice that ensures patient safety. However, most newly graduated nurses struggle to conduct clinical handovers as they lack sufficient communication skill competence and self-efficacy in this practice. This study aimed to examine the efficacy of a blended learning programme on the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Methods A randomised controlled design was used. A convenience sample of 96 final-year baccalaureate nursing students at a local university. Data were collected in 2020. Participants were randomly assigned to either an experimental group (n = 50) that received a blended learning programme with face-to-face training and an online module on handover practice, or a waitlist control group (n = 46) that received only face-to-face handover training during the study period and an online module immediately after the completion of data collection. The primary outcome was the communication skill competence and the secondary outcome was the self-efficacy of the participants in conducting clinical handovers. An analysis of covariance was used to examine the between-subjects effects on self-efficacy and communication skill competence in conducting clinical handovers after controlling for the significantly correlated variables. A paired sample t-test was used to determine the within-subjects effects on self-efficacy. Results The participants in the experimental group had significantly higher communication skill competence (p

Background: The COVID pandemic has highlighted the stresses experienced by our medical workforce, with worldwide publications attesting to high rates of depression, anxiety and burnout, particularly in junior doctors. Many studies focus on reporting on the prevalence of mental health issues, but not many report on interventional strategies. One of the most stressful interactions in the day of a junior doctor is the medical handover. The incorporation of kindness into clinical handover has coined the term 'KISBAR' to underline the importance of delivering handover in a kind manner. Aim: The aim is to analyse the efficacy of a novel intervention by introducing an emotional support representative to participate in the morning labour ward handover. Methods: We undertook an ethnographic constructivist qualitative research project in a tertiary hospital in Perth, Western Australia, using focus groups to explore the views of junior medical staff on the KISBAR handover tool in the specific context of labour ward handover. Fifty per cent of the total junior doctors from the hospital participated in this study. Results: Four dominant themes arose from analysis of the focus group discussions: (i) inherent stress experienced by junior doctors during the labour ward handover process, (ii) support strategies for junior doctors during labour ward handover; (iii) role modelling and the hidden curriculum aspects of communication from senior doctors at labour ward handover; and (iv) benefit of having an emotional support person present for labour ward handover. Conclusion: Our study confirmed the benefit of having an emotional support person present at labour ward handover: improved perception of safety and an environment that junior doctors found to be supportive. This is a novel and reproducible interventional strategy which is applicable to various obstetric units around Australia. [ABSTRACT FROM AUTHOR]

Aim: This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models. Background: Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context. Methods: This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility. Results: Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs. Conclusion: This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting. Implications for Nursing Management: Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse. [ABSTRACT FROM AUTHOR]

People living with HIV may move between health facilities: this is called 'transfer', and includes up- and down-referral based on clinical condition and lateral transfer (e.g. between primary healthcare [PHC] facilities for reasons such as geographic mobility or stigma). Transfers involving PHC facilities occur frequently and are associated with viraemia and disengagement. We reviewed the South African National Department of Health (NDOH) and Southern African HIV Clinicians Society websites and contacted NDOH officials to identify national guidelines applicable to HIV care in South Africa for recommendations on transfers involving PHC facilities. In total, 21/24 (88%) documents mentioned transfer, using the terms 'referral', 'linkage', 'transfer', 'transition' and 'handover'. Guidelines defined 'linkage to care' as connecting individuals to care after HIV testing, but other terms were not well defined. Documents emphasised transfers between different levels of the health system, and transfers between PHC facilities received limited attention. The transfer process was delineated for linkage to care, up- and down-referrals, but not for transfers between PHC facilities. Clinical management of patients transferring between PHC facilities and tracing of patients who requested transfers and missed their visits were not specified. Overall, transfers between PHC facilities were not well addressed and require attention to improve HIV treatment outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Nursing handover is an essential part of nursing practice to safe patient care, which occurs among nurses between shifts for transferring professional responsibility and accountability. However, there is limited information about the implementation and evaluation of nursing handover in Indonesian hospitals. Objective: This study aimed to describe the structures, processes, and barriers of the nursing handover in the Indonesian hospital context. Methods: This study employed a case study design in five inpatient units, especially in the medical-surgical wards of a referral hospital in Indonesia. The study was conducted from August to November 2018. A total of 100 handovers and 76 nurses were included. Focus group discussions were conducted in head nurses, nurse team leaders, and registered nurses. Observations were implemented to capture the handover process, including the number of the nurses in and out and the content of the information covered situation, background, assessment, and recommendations (SBAR). Data were analyzed using content analysis and fishbone analysis. Results: The nursing handover consisted of three phases: before, during, and after. The handover barriers were divided into manpower, material, money, method, environment, and machine. The content of handover varied according to nurses’ familiarity with the patients and their complexity. The nurses also actively participated during the handover process, although some nurses were absent in the handover time. About 75% of nurses had sufficient knowledge about the shift handover process using SBAR. The SBAR was adopted as a standard for handover, but no specific guideline or standard operating procedure. Conclusion: The results of this study can be used as basic information to develop a guideline of nursing handover and supervision in the context of hospitals in Indonesia and beyond. Funding: This study was funded by the Department of Nursing, Universitas Indonesia, Indonesia.

Aims: To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design: Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods: Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data. Results: Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications. Conclusions: Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact: Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals. [ABSTRACT FROM AUTHOR]

Background: A clinical handover is an essential nursing practice that ensures patient safety. However, most newly graduated nurses struggle to conduct clinical handovers as they lack sufficient communication skill competence and self-efficacy in this practice. This study aimed to examine the efficacy of a blended learning programme on the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Methods: A randomised controlled design was used. A convenience sample of 96 final-year baccalaureate nursing students at a local university. Data were collected in 2020. Participants were randomly assigned to either an experimental group (n = 50) that received a blended learning programme with face-to-face training and an online module on handover practice, or a waitlist control group (n = 46) that received only face-to-face handover training during the study period and an online module immediately after the completion of data collection. The primary outcome was the communication skill competence and the secondary outcome was the self-efficacy of the participants in conducting clinical handovers. An analysis of covariance was used to examine the between-subjects effects on selfefficacy and communication skill competence in conducting clinical handovers after controlling for the significantly correlated variables. A paired sample t-test was used to determine the within-subjects effects on self-efficacy. Results: The participants in the experimental group had significantly higher communication skill competence (p < 0.001) than those in the waitlist control group. Although both groups showed a significant improvement in selfefficacy, the mean scores of the experimental group were higher than those of the waitlist control group (p < 0.001). Conclusions: This study demonstrated the efficacy of a blended learning approach in improving the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Nurse educators should incorporate a blended learning approach into the nursing curriculum to optimise the content of training programmes for teaching nursing students in conducting clinical handovers. [ABSTRACT FROM AUTHOR]

Abstract Clinical handover is one of the most critical steps in a patient’s journey and is a core skill that needs to be taught to health professional students and junior clinicians. Performed well, clinical handover should ensure that lapses in continuity of patient care, errors and harm are reduced in the hospital or community setting. Handover, however, is often poorly performed, with critical detail being omitted and irrelevant detail included. Evidence suggests that the use of a structured, standardised framework for handover, such as ISBAR, improves patient outcomes. The ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework, endorsed by the World Health Organisation, provides a standardised approach to communication which can be used in any situation. In the complex clinical environment of healthcare today, ISBAR is suited to a wide range of clinical contexts, and works best when all parties are trained in using the same framework. It is essential that healthcare leaders and professionals from across the health disciplines work together to ensure good clinical handover practices are developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of health professional students and health professionals to ensure good quality handover practice. Using ISBAR as a framework, the purpose of this paper is to highlight key elements of effective clinical handover, and to explore teaching techniques that aim to ensure the framework is embedded in practice effectively.

Abstract Background Effective clinical handover is fundamental to clinical practice and recognised as a global quality and safety priority. Problems with clinical handover from the emergency department (ED) to inpatient ward across four hospitals in the Illawarra Shoalhaven Local Health District (ISLHD) were identified in a number of reportable clinical incidents. To address this, an ED to inpatient ward electronic clinical handover tool was developed and implemented. However, site uptake of the tool varied from 45 to 90%. Aim To determine the facilitators and barriers of the ED to Ward Handover Tool (EDWHAT) implementation and design strategy to improve local compliance and inform wider implementation. Methods An exploratory convergent mixed-method approach was used. Data were collected via a 13-item electronic survey informed by the Theoretical Domains Framework (TDF) distributed to eligible nurses across the health district. Descriptive statistics for quantitative data and thematic analysis for qualitative data were conducted. The data were then integrated and mapped to the TDF and the Behaviour Change Wheel to identify specific behaviour change techniques to support implementation. Results There were 300 respondents. The majority of nurses knew where to locate the tool (91.26%), but 45.79% felt that it was not adequate to ensure safe handover. The most frequently reported factors that hindered nurses from using the tool were inability to access a phone near a computer (44.32%) (environmental domain), being told to transfer the patient before being able to complete the form (39.93%) (reinforcement) and the other nurse receiving (or giving) the handover not using the form (38.83%) (social influence). An implementation checklist to identify barriers and solutions to future uptake was developed. Conclusion To improve uptake, the functionality, content, and flow of the handover tool must be revised, alongside environmental restructuring. Nurses would benefit from an awareness of each speciality’s needs to develop a shared mental model and monitoring, and enforcement of tool use should become part of a routine audit.

Clinical handover is a permanently or temporarily exchange of patient care between various health professionals. Number of researchers show a causal link between negative events and poor communication during handover supporting greater recognition of the role that handover plays in patient care quality and safety. The PEO framework was used to formulate the research question, and the main key term was used in a database search that included Medline, CINAHI-databases, British Nursing Index, National Institute for Health and Care Excellence (NICE), as well as studies from the Cochrane Collaboration, Science Direct, and the Education Resources Information Centre (ERIC) from 2007 to 2017. This evaluation includes 12 studies that were both eligible and relevant. The nurse shift handover was discovered to be a vital component of nursing while delivering care to patients, along with a multidimensional information transfer procedure and the enhancement of patient safety results. High levels of care can only be delivered by making high-quality information available. When the handover procedure is standardized, there is less patient information loss and an increase in the efficacy of communication practice at the same time. The goal of this systematic review is to determine the most effective intra-hospital handover technique or tool that nurses can use, as well as to fill a gap in the literature in which there appears to be no other systematic review that analyzes handover models in terms of patient care quality and safety. [ABSTRACT FROM AUTHOR]

Many nursing contexts have introduced bedside handover, where the person in care participates in the transfer of clinical information, with benefits for person, carers, and clinicians. This type of handover has been implemented across a number of mental health settings, but there is limited evidence regarding implementation approaches or of practice change. This study reports the development and evaluation of a co-produced education and support package. To evaluate changes in nurses' practice regarding bedside (person-side) handover following implementation of a structured education and support package. Multi-method design incorporating nurse surveys and chart audit. The survey and audit were conducted in 2019–2020 on two inpatient mental health units in a metropolitan health service immediately prior to, and 6 months after, implementation, with 70 survey responses and 52 files audited. Non-parametric tests assessed change, and text comments were reported. Significant improvements were observed in nurses' reports of confidence, the ability to maintain privacy, identified benefits for the person and in information transfer. In contrast, the chart audit identified no change in documentation of this practice. The implementation of a co-produced education and support package demonstrated positive practice change in engaging people receiving care in handover. This approach to handover provides increased opportunity for nurses to work in partnership with people receiving mental healthcare, facilitating collaborative person-centred care and shared decision making. [ABSTRACT FROM AUTHOR]

Background: Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses. Purpose: The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs. Methods: A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants. Results: Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified. Conclusion: Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training. [ABSTRACT FROM AUTHOR]

Abstract Background Good clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment. Methods Researchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied ‘live’ by receiving clinicians and from recorded handovers by academic assessors. The tool’s performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback. Results Reliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach’s alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups. Conclusions We have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting.

The aims of this study were to systematically assess the barriers and facilitators to evidence-based nursing handover in a clinical environment, and to identify potential adopters and attributes of evidence-based nursing handover for translation into practice. The study was conducted in the medical wards of a major tertiary referral hospital in Brisbane, Australia. Participants comprised registered and enrolled nurses permanently employed in the participating wards for at least three months prior to the commencement of study. Using a qualitative focus group design, a context specific assessment of the barriers and enablers to knowledge translation was performed through five semi-structured focus groups. Focus groups discussions were recorded by a registered court reporter using a stenotype machine for voice to text transcription, transcribed verbatim and de-identified for analysis. Focus group data were analysed using thematic analysis.Three themes emerged from the focus group discussions: 1) Content (information transferred); 2) Process (steps used to transfer accountability and responsibility for care); and 3) Environment (factors impacting on safe handover). Participants identified barriers to effective nursing handover including variability of handover content and process, uncertainty around sharing sensitive information, inconsistency around clarifying gaps through questioning during the handover, superficial patient involvement, time constraints and environmental challenges. Key facilitators discussed during the focus groups were the use of integrated electronic medical records, support and clear expectations from the nursing leadership and targeted handover education.During the focus group discussions, participants identified several barriers and facilitators to effective handover. These findings will guide the development of research translation strategies to support the implementation of best practice, standardised clinical handover.

The current Australian Medical Association doctors in training enterprise agreement dictates that hours beyond 38 or 43 ordinary hours per week incur overtime. Costly overtime has led to strict adherence to ordinary hours with dramatically reduced rostered and unrostered overtime. The stringent regulation over ordinary hours may protect doctors at a cost to training and potentially patient safety. Reduced shift duration adds to the number of clinical handovers, while reduced exposure to patients and training opportunities may prolong training time. Now is the time for renegotiation of working hours, which are most favourable for doctor training and well‐being. [ABSTRACT FROM AUTHOR]

Numerous reviews of nursing handover have been undertaken, but none have focused on the patient's role. To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Systematic mixed- methods review. Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barriers to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' discomfort encouraging patient participation and worries for sharing confidential and sensitive information. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and increasing the interpersonal approach during handover. Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses to achieve this and prepare patients to do this. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects. [ABSTRACT FROM AUTHOR]

Background: Effective clinical handover has always been integral to delivering safe, high‐quality care in medical wards. Aim: As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research. Methods: Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio‐recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection. Results: There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities. Conclusion: This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time‐sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability. [ABSTRACT FROM AUTHOR]

Abstract Background Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. Objective To explore nursing students' handover involvement during their clinical rotations and associated factors. Method This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. Results Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p < 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p < 0.001) in units with high 'quality of the learning environment' (β = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (β = −0.279, p < 0.001), or by a nurse on a daily basis (β = −0.253, p = 0.004), or by the staff (β = −0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. Conclusions Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Aims: To evaluate use of an evidence‐based discharge tool, the Post‐Anaesthetic Care Tool and its impact on nursing assessment, communication, and management of patients in the postanaesthetic care unit. Background: Postanaesthetic care unit nurses manage patients immediately after surgery and make clinical decisions on discharge readiness. There is a lack of evidence‐based guidance on assessing, documenting, and communicating the patient's postoperative experience. The Post‐Anaesthetic Care Tool, which includes instructions for assessing discharge readiness and incorporates the ISOBAR acronym, was developed following a comprehensive systematic review and expert consultation. Design and Methods: This quasiexperimental, multicentre, nonrandomized study was conducted in three postanaesthetic care units in Australia. Participants were nurses providing care to adults postgeneral anaesthesia. Episodes of care were observed before (N = 723) and after (N = 694) introduction of the evidence‐based tool. Statistical methods (Chi‐Square and Mann–Whitney U‐Tests) were undertaken to analyse nursing assessment, communication, and management outcomes before and after implementation of the Post‐Anaesthetic Care Tool. Results: The Post‐Anaesthetic Care Tool was associated with statistically significant improvements in the frequency of nursing assessment and responsiveness to complications including pain, nausea/vomiting and hypothermia. After the tool's introduction, nurses requested more medical reviews. This was associated with increased recognition of clinical deterioration and significant improvements in clarity of handover from the postanaesthetic care unit to the ward. Conclusions: The structured discharge tool, Post‐Anaesthetic Care Tool, was associated with improved nursing management of patients in the postanaesthetic care unit and enabled early identification and response to clinical concerns. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this literature review was to establish the scope of the literature about clinical handover from the operating room to Post Anaesthesia Care Unit (PACU) published in the last ten years and identify relevant key sources, theories, concepts and ideas. Method: The literature included in this review is divided into policy framework, practice, theoretical and primary research literature. Findings: This literature review demonstrates that either clinicians perceive clinical handover as informal, unstructured and inconsistent or transfer of information in handover as incomplete or unclearly expressed. Anaesthetists and PACU nurses differed in expectations of content and timing of information transfer. Conclusion: There is a need to develop training and educational strategies to improve clinical handover practice, particularly in a way that encourages collaboration. [ABSTRACT FROM AUTHOR]

Introduction: Clinical handover is defined as inter-clinician communication occurring at care interfaces. In this study, we analyse the clinical outcomes and physician attitudes associated with the implementation of a electronic clinical handover system in our medical department.Aim: The aim of this project was to introduce a reliable, standardised, reproducible method of communicating information regarding inpatients within our medical department. We also sought to assess the attitudes of physicians within our department to medical handover.Methods: We designed and implemented an electronic handover template with a protocol to guide staff as to its use. Handover was audited weekly. In addition, we surveyed attitudes of doctors to handover before and after our handover pilot.Results: An average of 32 patients were handed over each week. Compliance with mandatory handover of ICU/CCU patients averaged at 59%. Extrapolating our pilot results for the year would result in approximately 1655 handover events per annum in our department. One hundred percent of physicians surveyed felt that documentation of handover was beneficial, and staff satisfaction with handover improved after initiation of the pilot (81 vs 24%, p = 0.000914). While 64% of staff were concerned that typed electronic handover would increase their workload, only 6% of the post pilot survey group felt that it did increase workload significantly.Conclusion: Electronic clinical handover is feasible and practical within the Irish healthcare system. In addition, it was found in our study to be attractive and effective to physicians without increasing their workload. [ABSTRACT FROM AUTHOR]

Background Numerous reviews of nursing handover have been undertaken, but none have focused on the patients’ role. Objectives To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Design Systematic mixed- methods review. Data sources Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Review methods Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Results Segregated synthesis of research of patients’ perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses’ perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses’ concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Conclusions Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects. [ABSTRACT FROM AUTHOR]

Aim To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. Background Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety. Design An explorative, qualitative design using focused ethnography was applied to the study. Methods Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU nurses in January-February 2016. Observation notes and interview transcripts were analysed using content analysis. Findings The theme 'Communicative interaction as a process of sharing and adopting ownership' and the subtheme 'Communicative interaction influenced by nurses individual expectations towards patient status and the handing over process' emerged from observation notes. From transcribed focus group interviews, the theme 'Balancing and negotiating when passing on, consuming and adapting knowledge' was identified. Conclusion A lack of shared goals regarding handing over patients from a high monitoring unit to general wards causes communicative and collaborative difficulties, loss of information and potential risks to patients. Organizational attention in relation to ICU discharge is crucial to improve collaboration, communication and patient safety. [ABSTRACT FROM AUTHOR]

Background: Good clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment. Methods: Researchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied 'live' by receiving clinicians and from recorded handovers by academic assessors. The tool's performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback. Results: Reliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach's alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups. Conclusions: We have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting. [ABSTRACT FROM AUTHOR]

Objective The present paper describes our experience of developing and piloting a best practice model of medical clinical handover. Secondary aims were to improve reliability of communication, identify negative effects on patient care and assess staff adherence and acceptance of the process. Methods We described existing handover practice. We designed and implemented a process incorporating bedside handover, the Identification, Situation, Background, Assessment, Requirements and Requests ( ISBAR) tool and handover documentation. We audited the process and surveyed doctors before and after the intervention regarding their practice and preferences. Results Existing handover practice was remote from the patient, neither standardised nor documented. The new process resulted in a median 87% (95% CI 70.4-92.1) of handovers in the presence of the patient. ISBAR elements were consistently communicated, median 100% (95% CI 91.8-100). Risk events were directly identified in a median 8.3% (95% CI 0.0-13.8) of bedside handovers. Handover documentation did not improve. FACEM and registrar perception that bedside handover improves patient care fell from 71%, 80% to 56%, 58%, respectively. Preference for bedside handover fell from 79% and 80%, respectively, to being evenly divided between bedside and centralised models; 80.9% of respondents reported that ISBAR improved communication. Conclusion Bedside handover using ISBAR resulted in improved patient involvement, communication and a non-significant trend to improved patient safety. Despite a majority of doctors acknowledging these findings, preference remained for a centralised handover using ISBAR. Gaining staff acceptance of a process change is essential to its success. A barrier to acceptance could be that staff are time-poor. We suggest handover processes can be strengthened by adequate staffing and small, incremental improvements to existing models combined with auditing of outcomes. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of a medical education session on the implementation of a new change of shift medical clinical handover format in an urban hospital ED. Methods This pilot study used a pre- and post-intervention design. The intervention consisted of a 1 h education session to teach a new handover format, SBARM (Situation, Background, Assessment, Recommendation, Medication). Data were collected through observations of doctors performing clinical handover and individual interviews with participants. Results The educational intervention led to an increased focus on checking medication charts, but had minimal effect on changing other aspects of clinical handover at doctors' change of shift times. Perceived increased time spent on handover using the new system was seen as a major barrier to the implementation of SBARM. The addition of 'M' to ' SBAR' heightened awareness of checking medication and fluid charts. Conclusion Time pressures need to be taken into consideration when introducing changes to current processes. Also, it is recommended that, in addition to ongoing education, senior clinicians are engaged during the planning and execution stages of changes to practice. [ABSTRACT FROM AUTHOR]

Interprofessional education is an important element in the preparation of healthcare students who can communicate effectively and work collaboratively. A grant from Health Workforce Australia funded a shared nursing, paramedicine, and physiotherapy simulation suite and a staff member dedicated to interprofessional simulation, with the aim of increasing high fidelity simulation within and across the three professions. This article describes the development process and pilot testing of four purpose-designed interprofessional handover scenarios for paramedic, nursing, and physiotherapy students. The scenarios tracked an elderly patient (manikin) with a fractured neck of femur from pre-hospital to postoperative assessment and handover. The National League of Nursing Simulation Design Scale was used to evaluate the scenarios. Students’ feedback indicated they considered the simulations to be relevant to their practice, with a high level of fidelity. This study re-emphasises the importance of pilot testing simulations before use in large-scale studies. [ABSTRACT FROM PUBLISHER]

Background: A patient handover is a critical process in health care services in which nurses are typically engaged several times in each working day. Aim: The purpose of this study was to determine the approaches and attitudes of nurses regarding clinical handover in Turkey. Method: This study, planned as descriptive and cross sectional, was conducted between April and July 2013 in seven institutions located in a city of Turkey. The sample group consisted of a total of 480 nurses. A personal information form and a questionnaire on clinical handover were used in this study. Results: In this study, the positive aspects of clinical handover mostly indicated by the nurses were as follows; “Simplifies the follow-up of patient information”, “Simplifies the acquisition of information about the patient and the disease” and “Gives an opportunity to get information that I did not know or did not understand” (respectively 80.2%, 74.2%, 67.7%). The negative aspects of clinical handover mostly specified by the nurses were as follows; “Clinical handover takes too much time” (24.4%) and “increases work load” (14.4%). Conclusions: It was determined that nurses indicated that while clinical handover had advantages such as the acquisition of information about the patient and the disease and the follow-up of patient information, it had disadvantages such as taking too much time and increasing the work load. [ABSTRACT FROM AUTHOR]

Background: Patient handover continues to be an international health priority in the prevention of patient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams., Objectives/aim: To design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients., Methods: A multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention., Results: Eleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient introduction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems., Conclusion: Precise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma patients. Further improvements are required to reduce the failure to hand over essential patient information., Competing Interests: Conflict of interest The authors declare there is no conflict of interest., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)