Bernice Redley1, Mari Botti2, Beverley Wood3, Tracey Bucknall4. 1. School of Nursing and Midwifery, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia; Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia. Electronic address: Bernice.redley@deakin.edu.au. 2. School of Nursing and Midwifery, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia; Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia. 3. Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia. 4. School of Nursing and Midwifery, Deakin University (Burwood Campus), Geelong, 3216, VIC, Australia.
Abstract
BACKGROUND: Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. METHODS: Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. RESULTS: Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. CONCLUSIONS: Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers.
BACKGROUND: Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. METHODS: Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. RESULTS: Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. CONCLUSIONS: Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers.