Project title
Understanding the scope and scale of clinical handover issues in emergency surgery in Ireland
Country
Ireland
Background
Poor communication contributes significantly to adverse events in healthcare. Despite established strategies designed to mitigate communication failures, patients experience significant risk and preventable harm, including death. Clinical handovers represent a particular area of risk for communication breakdowns. Handovers occur frequently throughout daily clinical practice when one clinical provider ‘hands over’ patient care responsibility to another provider.
Compared with pre-operative surgical safety checklists, the acute post-operative setting has received only limited attention. Unfortunately, surgical teams receive little training in safe and effective handover, arguably one of the most vulnerable times in the patient journey. While a body of literature on handover for other specialties exists, surgical teams and their patients have different needs. To date, handover-related surgical research has emphasised electronic processes such as checklists, patient lists, or computerised programs, while placing less emphasis on the influence of team communication and education on handover practices.
Summary
This study identified a number of significant shortfalls in the process of clinical handover after surgery. A number of barriers to best practice were identified and a ‘blueprint’ for future surgical handover educational programmes was designed.
Outcome
A systematic review1, demonstrated that while good quality surgical handover has the potential to improve patient outcomes, research to date has focused primarily on the use of handover tools or documents. This suggests a misconception that handover is a one-way process, rather than a conversation.
Additionally, none of the 41 studies included in the review rigorously applied an implementation framework to support the changes to the handover process, making sustainability of intervention unlikely.
RCSI carried out a multi-site observational study of surgical handover in two hospitals2, finding that despite 20 years of published handover guidelines, there is still poor compliance with best practice in ‘real-world’ settings. This process identified important barriers to, and enablers of, good practice, and resulted in clear recommendations to improve handover.
It also resulted in the identification of a combination of methods which offer a robust framework for future handover assessment studies. To ensure that the stakeholder view was well-represented, a national survey of surgical doctors was completed, further evaluating current practice, barriers to, and enablers of handover improvement (currently undergoing peer review). Lastly, using critical review methodology to identify best available evidence, a ‘blueprint’ was designed which can be used to design any future surgical handover educational programmes (currently undergoing peer review ).