Examining communication and team performance during clinical handover in a complex environment: the private sector post‐anaesthetic care unit

Abstract

Threats to patient safety during clinical handover have been identified as an ongoing problem in health care delivery. In complex handover situations, organisational, cultural, behavioural and environmental factors associated with team performance can affect patient safety by undermining the stability of team functioning and the effectiveness of interprofessional communication. We present a practical framework for promoting systematic, comprehensive measurement of the factors involved in clinical handover. The framework can be used to develop viable solutions to the problems of clinical handover. The framework was devised and used in a recent project examining interprofessional communication and team performance during clinical handover in post‐anaesthetic care units. The framework combines five key concepts: clinical governance, clinician engagement, ecological validity, safety culture and team climate, and sustainability. We believe that use of this framework will help overcome the limitations of previous research that has not taken into account the complex and multifaceted influences on clinical handover and interprofessional communication.

Exploring the structure and organization of information within nursing clinical handovers

“…The idea of context‐specific mnemonics has considerable benefit where SBAR is used where the patient is deteriorating or emergency departments where unstable conditions exist for patients. Others have suggested that competing initiatives could result in ‘reform fatigue’ . Similarly, Botti argued that the ‘uptake of clinical handover tools has been low’, suggesting that there is limited ecological validity or ‘the degree to which interpretations or innovations reflect the real‐life situations in which they are to be applied’ (p. S159) .…”

Clinical handover: critical communications

“…The complexity of health care means that maintaining the continuity of patient care is a challenging process. As the article by https://doi.org/10.5694/j.1326-5377.2009.tb02626.x on maximising patient safety in complex handover situations states, “it is unlikely that any one improvement strategy will be appropriate for all” 16 . Training in communication within a team seems to be a helpful strategy, as demonstrated by https://doi.org/10.5694/j.1326-5377.2009.tb02619.x in a study of TeamSTEPPS (team strategies and tools to enhance performance and patient safety) 17 .…”

An observational study of patient care outcomes sensitive to handover quality in the Post‐Anaesthetic Care Unit

“…The methods, adapted from quality improvement (Ben‐Tovim et al., ; Calder et al., ), used a novel patient mapping approach and data collection guided by tools developed for PACU handover improvement (Agarwal et al., ; Botti et al, ; Redley et al ) to explore the impact of handover communication in complex clinical environments. Integration of description using quantitative and qualitative data offered robust data and the opportunity to explore the detail of care delivery in the PACU.…”

“…The anaesthetist to nurse handover was observed for compliance with elements of the Connect, Observe, Listen, Delegate (COLD) quality improvement tool developed previously by one of the researchers (Botti et al, ; Redley et al ). The Listen step of this process included the elements of Identify, Situation, Observations, Background, Assessment and Recommendation (ISoBAR) (Porteous, Stewart‐Wynne, Connolly, & Crommelin, ; Yee, Wong, & Turner, ) recommended to standardise the verbal communication during PACU handover (Agarwal et al., ; Botti et al, ; Redley et al ).…”