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The success of handoff communication in the clinical setting determines patients’ safety. Birmingham et al. (2015) conducted a qualitative study to assess the perspective of surgical nurses regarding the processes that inhibit or facilitate the patients’ safety during handoff and intra-shift. According to Birmingham et al. (2015), viable handoff communication is essential in ensuring the safety of patients. In particular, the communication strategies implemented during intra-shift processes influence the effectiveness of handoff procedures (Harris-Hines, 2020). The study established that the capability of outgoing nurses in comprehending information intra-shift is vital in depicting the comprehensive health situation during handoff and enabling a smooth transition. Furthermore, when oncoming nurses understand the conveyed information during handoff, all the practitioners collectively understand each other, minimizing medical errors and facilitating patient safety.
Structural handovers determine the patient health outcomes in the clinical health setting. Bukoh et al. (2020) assessed the viability of structured handovers in facilitating the health outcomes of patients inwards. In particular, a standardized and structured nursing handover can facilitate reduced mortality rates, minimized stay durations in hospitals, suppressed patient fall rates, and efficient emergency responses (Bukoh et al., 2020). Furthermore, Bukoh et al. (2020) assessed various electronic databases such as Scopus, Excerpta Medica dataBase (EMBASE), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medical Literature Analysis and Retrieval System Online (MEDLINE) to review the efficacy of structured handover procedures. The study outcomes ascertained that the present structured handover frameworks are essential in mitigating hard handovers, for instance, documentation challenges, information inaccuracy, and data omission.
Further, Funk et al. (2016) evaluated the significance of structured handover in clinical care units through surveys of pre-quality and post-quality improvement approaches. The study affirmed that a structured handover worksheet facilitates satisfaction in healthcare providers and improves communication of information contained in the handover.
Various tools have been developed to improve the efficacy of bedside handoff. Furthermore, Campbell and Dontje (2019) carried out a study to design, enact, and assess bedside handoff’s effect on nursing shift change in medical facilities’ emergency rooms. Since the health outcomes in emergency departments can be adversely affected by medical errors entailed in unplanned handoff procedures, the study aimed at developing a practice-improving project (Campbell & Dontje, 2019). To achieve this purpose, the researchers developed the situation, background, assessment, and recommendation (SBAR) tool utilized in communication during nurse handoffs. The research established that SBAR bedside report is essential to utilize since it reduces missing patient data to a larger extent compared to pre-intervention practices.
Besides, some recent studies champion standardized handoffs and effective communication to improve health outcomes. Canale (2018) strived to develop and implement a standardized handoff for sedated individuals. In particular, the study was geared towards implementing a standardized handoff to facilitate the continuity and quality of medical workers’ satisfaction, patient safety perceptions, and information transfer. In numerous healthcare systems, communication errors during handoffs mostly lead to perioperative mortality and morbidity (Dingle, 2019). Additionally, poor communication results in above 80% of medical errors (Canale, 2018). The study established that the quick and informal patient transfer by anesthesia providers facilitates miscommunication and error risks. The study’s methodology involved selecting 20 CRNAs through a snowball sampling to generate Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) (Canale, 2018). After finishing up a post-intervention questionnaire, the results indicated that the TeamSTEPPS improved the continuity and quality of the medical care workers’ satisfaction, patient safety perceptions, and information transfer.
One significant handoff tool in recent times is the Situation, Background, Assessment, and Recommendation (SBAR). Castelino and Latha (2015) investigated the importance of the (SBAR) tool in improving the efficacy of nurse handoff. To achieve the study’s objective, the researchers assessed 72 handoff events carried out by 72 nurses in both control and experimental groups and collected data via practice checklists, structured questionnaires, and demographic proformas. The results indicated that the after-test knowledge scores rose from 3.47 to 7.72 following the implementation of the SBAR tools, insinuating their effectiveness in improving handoff efficacy.
There have been split opinions on the effectiveness of minimized but precise handoff frameworks versus the exhaustive formal types. Clanton et al. (2016) strived to compare the impacts of minimized but precise handoff strategy to a comprehensive formal handoff framework on the health outcomes of patients. Numerous healthcare facilities focus immense resources and time on handling patient handoffs. The methodology involved stratifying the two experimental groups composed of 5157 distinct patient admissions. The study established that there is no significant difference in the health outcomes of the two groups. However, the study found that a minimalistic handoff strategy can save resources and time without adversely affecting the health outcomes of patients.
Furthermore, the efficacy of trainee handoffs in healthcare has drawn widespread attention. Clarke et al. (2017) assessed the trainee experience, effectiveness, and utility related to the enactment of original, electronic, and standard handoff approaches. The study carried out a potential intervention assessment of trainee handoffs of sick persons going through intense oncology procedures. Furthermore, the research team assessed the pre-implementation data by tracking delinquencies, direct observation, and trainee surveys. The standardized electronic handoff equipment was designed in a REDCap database and augmented via face-to-face interactions or direct communication. Besides, statistical analyses were used in assessing the trainee workflow, communication errors, and handoff compliance during postimplementation. The study results indicate that standardized electronic equipment integrated with uninterrupted communication for patients with high acuity can raise the efficiency, accuracy, and observation of trainee-to-trainee handoff communication.
To develop training recommendations for clinical handover, some studies evaluate past literature. Clarke (2018) conducted a literature review to ascertain the history and efficacy of healthcare handovers from surgical rooms to Post Anaesthesia Care units (PACU) in the past decade. The assessed literature included in the review was categorized into primary research, theoretical, practice, and policy framework literature. Furthermore, the study established that either information transfer in handover is unclearly manifested or incomplete, or medical personnel perceive clinical handover as inconsistent, unstructured, and informal. Furthermore, the study concludes that there is a necessity to enact educational and training measures to facilitate positive outcomes in the clinical handover, especially in a manner that promotes collaboration.
Upholding clear and comprehensible verbal communication is essential for improving patient outcomes. Daniels et al. (2017) investigated opportunities for facilitating effective communication in delivery and labor rooms through simulation. The study assessed the prevalent verbal communication barriers in delivery and labor rooms and effective strategies for eradicating the obstacles. According to Daniels et al. (2017), communication errors are key proponents of negative health results in labor and delivery units (L&D). In the research, medical practitioners in L&D departments took part in 3 simulated clinical situations. Besides, the situations were then recorded and analyzed to locate repeated questions, and the repetition frequency was evaluated. The results indicate that questions were repeated in 27 situations and majorly concentrated on aspects such as personnel, maternal clinical status, and historical data.
The SBAR is vital in facilitating handoff procedures in healthcare. Dalky et al. (2020) evaluated the significance of SBAR in facilitating handoff procedures in healthcare. The SBAR refers to a standardized handover instrument that is prevalently utilized in nursing practice (Dalky et al., 2020). Besides, the SBAR facilitates positive outcomes in healthcare quality and staff communication. The study aimed to assess SBAR implementation among nurses in Jordan ICUs. The research assessed 71 intensive care unit nurses through a 43-item questionnaire (Dalky et al., 2020). The questionnaire evaluated SBAR efficacy marked by job satisfaction levels, leadership and team, communication, and general relationships. The results indicate that integrating SBAR in healthcare settings facilitates knowledge scores in job satisfaction, communications, and general relationships. Conover et al. (2020) further investigated the effectiveness of the simulation of SBAR and patient handoff for nursing students who have not yet acquired practice licenses. The study established that including SBAR simulations with patient handoff improves the student’s collaboration, communication, and information exchange, thereby facilitating positive patient outcomes.
Incorporating practical handoff tools in the nursing units can help suppress medical errors. Deal (2020) carried out a study to integrate the ISHAPED handoff instrument into a present operational nursing unit and validate past handoff communication research. The study focused on answering the gap in the strategies for improving nurse-to-nurse communication during handoff processes. Besides, the study evaluated how TeamSTEPPS communication initiatives facilitate job satisfaction among nurses communicating during shifts compared to the present practices. Consequently, a shift report assessment was carried out for post-implementation and pre-implementation data pertaining to the nurses’ ideologies on handoff communication. The study results indicate that utilizing the TeamSTEPPS strategy to implement bedside shifts facilitated collaboration between patients and nurses as well as among the nurses (Deal, 2020). Besides, integrating the ISHAPED handoff tool with the bedside shift report enabled nurses to become more effective in caring for their patients due to thorough, quality, and consistent handoff information. The integration also facilitated efficient communication between night and day shift nurses, inhibiting healthcare-related errors.
The SBAR tool influences decision-making initiatives in healthcare. Etemadifar (2020) investigated the impact of the SBAR-reliant patient safety emancipation initiative on the clinical decisions made by a nurse in ICUs. The study involved a quasi-experiment carried out on sixty ICU nurses in Hajar and Ayatollah hospitals in 1398. Besides, the participants were randomly allocated to control and experimental groups with thirty people each. The results indicate that the clinical decision-making efficacy of the experimental ICU nurse group improved from 69.1 to 80.8 after the intervention. Contrastingly, the scores of the control group only improved from 70.6 to 71.1 after the intervention. The research affirmed that implementing the SBAR strategy in nurse education programs improves their decision-making efficacy.
The strength of effective handover processes lies in communication efficacy. Streeter et al. (2015) evaluated the communication practices that characterize effective handover procedures. Miscommunication between nurses when carrying out patient handoffs results in approximately 80% of the grave medical care errors (Streeter et al., 2015). The qualitative research located distinct communication practices related to a communicatively effective patient handoff during a shift change. The research team gathered data from 286 nurse practitioners via online questionnaires. The study results affirmed that socio-emotional communication behaviors and information exchange practices such as seeking, providing, and verifying information were dominant in the best nursing handoffs.
Due to diversity in the clinical setting, the language barrier can be facilitated through bilingual training. Pun et al. (2020) investigated the effective training programs for handover in bilingual healthcare facilities. Accountability is vital in facilitating high quality during handover since its design necessitates a systematic strategy of assessing nurses’ actions (Esaka, 2020). Against this backdrop, the study entailed administering a training program reliant on CARE protocol to fifty nurses, followed by evaluating their practices and perceptions. The study results indicate that the training programs need to conform to an organized handover framework, promote effective communication with incoming nurses and promote the perfect transfer of functions by the outgoing medical practitioners.
Tracking documented and undocumented information can help reduce medical errors. Patterson et al. (2019) aimed to identify the role of non-documentation communication in nursing handovers, the location of documented information, and the data content in verbal reports. Translating approved handover reports from nurses in non-emergency scenarios to nurses in critical scenarios is difficult (Patterson et al., 2019). The descriptive research evaluated twenty reports on twenty-seven patients from two ICUs. The study established that handover information is majorly documented in previous medical history, orders, lab results, nurse flow-sheets, and administration records. Besides, the results indicate that the typically undocumented information involves mentorship, coordination work, sharing clinical interpretations, and offering patient-focused services.
Furthermore, effective communication, teamwork, and accountability improve success in the patient handoff. Lee et al. (2016) investigated how various aspects of patient safety culture relate to patient safety perceptions and clinical handoffs. The study assessed the statistical connections between transition practices and handoffs, patient safety, and patient safety culture. The study results indicate that appropriate accountability, responsibility, and information handoff are essential in facilitating positive patient safety perceptions. Besides, communication and feedback on medical errors were positively attributed to the effective transfer of patient information. Furthermore, the frequency of events and teamwork in clinical units were positively associated with an effective handoff of responsibilities when swapping shifts.
References
Birmingham, P., Buffum, M., Blegen, M., & Lyndon, A. (2015). Handoffs and patient safety: Grasping the story and painting a full picture.Western Journal of Nursing Research, 37(11), 1458-1478.
Bukoh, M. X., & Siah, C. J. R. (2020). A systematic review on the structured handover interventions between nurses in improving patient safety outcomes. Journal of Nursing Management, 28(3), 744-755.
Campbell, D., & Dontje, K. (2019). Implementing bedside handoff in the emergency department: A practice improvement project. Journal of Emergency Nursing, 45(2), 149-154.
Canale, M. (2018). Implementation of a standardized handoff of anesthetized patients. American Association of Nurse Anesthetists Journal, 86(2), 137-145.
Castelino, F., & Latha, T. (2015). Effectiveness of protocol on situation, background, assessment, recommendation technique of communication among nurses during patients’ handoff in a tertiary care hospital. International Journal of Nursing Education, 7(1), 123-127. Web.
Clanton, J., Gardner, A., Subichin, M., McAlvanah, P., Hardy, W., Shah, A., & Porter, J. (2016). Patient hand-off initiation and evaluation (PHONE) study: A randomized trial of patient handoff methods. The American Journal of Surgery, 213(2017), 299-306.
Clarke, C., Patel, S., Day, R., George, S., Sweeney, C., De Oca, G., & Aloia, T. (2016). Implementation of a standardized electronic tool improves 49 compliance, accuracy, and efficiency of trainee-to-trainee patient care handoffs after complex general surgical oncology procedures. Surgery, 161(3), 869-875.
Clarke, S. (2018). Clinical handover of immediate post-operative patients: A literature review. Journal of Perioperative Nursing, 31(2), 29-35. Web.
Conover, K. M., Cummings, D., & Walsh, J. A. (2020). Simulation patient handoff and SBAR for second year prelicensure nursing students.
Dalky, H. F., Al-Jaradeen, R. S., & AbuAlRrub, R. F. (2020). Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimensions of Critical Care Nursing, 39(6), 339-347.
Daniels, K., Hamilton, C., Crowe, S., Lipman, S., Halamek, L., & Lee, H. (2017). Opportunities to foster efficient communication in labor and delivery using simulation.American Journal of Perinatology Reports, 7(1), 44-48.
Deal, J. (2020). Nurse-to-nurse handoff communication using the TeamSTEPPS approach. Feedback and assessment tools for handoffs: A systematic review. Journal of Graduate Medical Education, 9(1), 18-32. Web.
Dingle, I. (2019). Development and Evaluation of a Women’s Health Nurse Practitioner Directed End of Shift Handoff Tool to Standardize Obstetrical Provider Communication in an Academic Medical Center. . . Wilmington University (Delaware). Proquest Dissertations Publishing.
Esaka, A. R. (2020). Development and Evaluation of a Nurse Practitioner-Directed Transfer Process for Patients Admitted to an Observation Unit in an Academic Medical Center . . Wilmington University (Delaware). Proquest Dissertations Publishing.
Etemadifar, S., Sedighi, Z., Masoudi, R., & Sedehi, M. (2020). Evaluation of the effect of SBAR-based patient safety training program on nurses’ clinical decision-making in the intensive care unit. Journal of Clinical Nursing and Midwifery, 9(2), 651-659.
Funk, E., Taicher, B., Thompson, J., Iannello, K., Morgan, B., & Hawks, S. (2016). Structured handover in the pediatric postanesthesia care unit. Journal of PeriAnesthesia Nursing, 31(1), 63-72.
Harris-Hines, N. (2020). Development and Evaluation of a Nurse Leader-Directed Nurse-To-Nurse Handoff for Patients Transitioning from the Emergency Department to an Inpatient Unit Within a Veterans Affairs Medical Center . . Wilmington University (Delaware). Proquest Dissertations Publishing.
Lee, S., Phan, P. H., Dorman, T., Weaver, S. J., & Pronovost, P. J. (2016). Handoffs, safety culture, and practices: Evidence from the hospital survey on patient safety culture. BioMed Central Health Services Research, 16(254), 1-8.
Patterson, E. S., McIntire, A., Beecroft, N., Happ, M. B., & Moffatt-Bruce, S. D. (2019). Nursing Handovers in Critical Care: A Retrospective Analysis of Information Content and Function.Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 8 (1), 4-8.
Pun, J., Chan, E. A., Eggins, S., & Slade, D. (2020). Training in communication and interaction during shift-to-shift nursing handovers in a bilingual hospital: A case study. Nurse Education today, 84, 104212.
Streeter, A. R., Grant-Harrington, N., & Lane, D. R. (2015). Communication behavior associated with the competent nursing handoff. Journal of Applied Communication Research, 43(3), 294-314. Web.
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