Handover of patient care has been an ongoing problem within the health care sector. The process remains highly variable and there is a threat to patient safety. Despite the general belief that handover transitions in patient care have become routine, not enough attention or research has been directed at improving this period of care. For this reason there is a need to provide an analysis of the communication processes during handover. A study was conducted of the handover process among doctors during shift changes within a hospital setting. The results suggested a need for process change. Results revealed a handover process which was unstructured, informal and error prone, with the majority of doctors noting that there was no standard or formal procedure for handover. The research found that the majority of hospital doctors recognised the potential benefits MAINTAINING CONTINUITY BETWEEN WORK SHIFTS is important in all continuous process operations, especially in the health care sector. It is particularly crucial when one considers the continuity of care a hospitalised patient requires, which extends past a single doctor or team. A shift handover mechanism is needed to allow personnel changes with minimum disruption to the functioning of a ward or unit in a 24-hour work context. The goal of handover is the accurate and reliable communication of task-specific patient information across shift changes, thereby ensuring a relatively safe and effective continuous work environment. 1 The motivation behind this research is to gain a better understanding of how handover operates and to identify recommendations to improve the process. Handover in hospitalsIn most hospitals, clinical records are still stored on paper. 2 Medical staff keep track of current patients' conditions using hand-written charts. These charts are then either left at the patient' s bed or at the service bench at each ward. The work of the Institute of Medicine has pointed out the inefficiencies in paper-based systems, such as What is known about the topic? The nature of health care delivery regularly requires the transfer of responsibility for patients from one health care professional to another. While there have been concerns raised about the effectiveness of the handover process there are relatively few medical studies describing or promoting safe transition methods. What does this paper add?This paper reports on the results of a study of medical handover at one NSW hospital that found the handover process to be informal, unstructured and a possible contributing factor to errors in patient care. The study comprised a questionnaire completed by a range of medical staff, interviews and direct observation of the handover process by the authors. What are the implications for practitioners?Hospital managers and clinician leaders should review and look for ways to improve the quality and safety of the handover process. Specifically, the authors suggest the need for standard handover procedures to be developed throughout the hospital. Australian ...
This article compares the attitudes of Australian and Swedish patients towards the use of computerised medical records and unique identifiers in medical practices in Australia and Sweden. A Swedish translation of an Australian survey was conducted and results were compared. Surveys were distributed to patients at a medical practice in Sweden in 2003 and compared to the results of an Australian study by Bomba and Land (2003). Results: Based on the survey samples (Australia N=271 and Sweden N=55), 91% of Swedish respondents and 78% of Australian respondents gave a positive appraisal of the use of computers in health care. Of the Swedish respondents, 93% agreed that the computer-based patient record is an essential technology for health care in the future, while 86% of the Australian respondents agreed. Overwhelmingly, 95% of Swedish respondents and 91% of Australian respondents stated that the use of computers did not interfere with the doctor-patient consultation. Both groups preferred biometric identification as the method for uniquely identifying patients but differed in their preferred method to store medical information - a combination of central database and smart card for Australian respondents and central database for Swedish respondents. This analysis indicates that patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden are positive; however, there are concerns over information privacy and security. These concerns need to be taken into account in any future development of a national computer health network.
Medication errors are common in public hospitals, with the majority at the prescribing stage of the medication pathway. Electronic prescribing decision support (EPDS) is a rules-based computer system that can be used by clinicians to warn against such errors to improve patient safety and support staff workflows. Despite its apparent advantages, this technology has not been widely adopted in Australian public hospitals for inpatient prescribing. A case study using Sauer's (1993) Triangle of Dependencies Model was conducted in 2003 into the feasibility of implementing an EPDS system at an Australian public hospital in New South Wales. It was found not feasible to implement an EPDS at the hospital studied due to the legacy patient administration system, low availability of information technology on the wards, differing stakeholder views, legislation, and the Independent Pricing and Regulatory Tribunal of NSW report recommendations. A statewide standard was preferred, with an agreed specification framework identifying basic core data items and functions that an EPDS must meet which can then be used by area health services to: (i) choose a solution which best meets their contextual needs; and (ii) engage vendors to tender for building an open source (non-proprietary) system based on
Within the field of consumer health informatics there is a need to develop transparent validation methods and rating instruments both of sufficient complexity and reliability to help designers, evaluators and patients to evaluate the quality of health web sites and health information on the Web. Further refinement and validation of the Bomba and Land Consumer Health Website Rating Index (v.1) was conducted. This paper reports on the validation approach utilised (a combination of the Delphi Technique and Sullivan's 5 step process) to produce version 2 of the Bomba and Land Index. Disciplines Business | Social and Behavioral Sciences
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