An Experimental Comparison of Handover Methods

Abstract

Ann R Coll Surg Engl 2007; 89: 298-300 298Medical handover is 'the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis'.1 The implementation of the New Deal and the European Working Time Directive has meant that junior doctors are increasingly working in shifts and that handover of clinical information is taking place more frequently. There is reduced continuity of care with patients often being looked after by more than one group of doctors on any given day.3 In many instances, doctors have no day-to-day contact with patients for whom they are responsible in the outof-hours period.2 There are many published examples of cases where poor communication between doctors has had serious consequences for patients; 3 for these reasons, it is now well recognised that accurate handover of clinical information is of great importance to patient safety. 1There are currently many different handover methods being used in clinical practice. 4 Often, a verbal handover is conducted, either by telephone or in person, where the recipient of the handover may or may not take notes to refer to over the course of his shift. Some groups arrange for a handover book or folder to be used so that teams can leave messages about patients of particular concern. In this case, there may be no verbal contact at all. Increasingly, more formal pre-prepared handover sheets are being used which contain information about all of the patients belonging to that particular team.5 This can be typed on a computer and printed out for the on-call doctor for his reference. However, this process inevitably takes more time and effort.Despite this variation in clinical practice, there is very little prospective experimental evidence in the literature investigating optimal methods of handover. The British Medical Association, in conjunction with the General Medical Council, NHS Modernisation agency, National Patient Safety Agency and the Junior Doctors Committee have recently published guidelines 4 for safe handover, but these are based largely on expert opinion. We designed a study to assess the differences in information retention for different handover styles. The styles examined included a purely verbal style, a verbal with note-taking style and a handover using a pre-prepared sheet.

Are weekend handovers of adequate quality for the on-call general medical team?

“…9 Bhabra et al have shown, using simulated patient handovers, that verbalonly handover leads to considerable loss of information compared to verbal handover with written notes. 10 When information loss was analysed, important and less important information in patient handover were lost at a similar rate. Ferran et al studied the use of standardised proformas to improve patient handover, auditing information handover for trauma patients before and after the introduction of a proforma.…”

Clinical Handover among Physicians: A Survey in a North Eastern Italian Academic Hospital

“…A verbal report has the potential weakness of poor retention of information by the receiver, and there may be discrepancies between the reported status and the actual patient status because of memory failure on the part of the reporter (Frankel, 2012). Literature shows that after five handover cycles, only 2.5% of patient information was retained using the verbal-only handover method while 85.5% was retained when using the verbal with note taking method and 99% was retained when a printed handout containing all patient information was used (Bhabra et al, 2007).…”

Shift-to-shift handoff: A comparison between two methods of conveying essential information in a University Hospital in North-eastern Italy

“…A structured pre-printed form, a new method for collecting and recalling data during the shift-to-shift handoff was chosen because it had already been shown in literature to be the most effective [13,15,16] . This method is supported by studies that encourage the use of a consistent pre-printed forms with relevant patient information during shift report, with less reliance on verbal-only reports, in order to optimize communication.…”