Does clinical handover promote situation awareness? Implications for person-centered healthcare

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Published: Jun 25, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i2.227
Keywords:
Acute medicine clinical handover human factors surgery person-centered healthcare obstetrics & gynecology quality of care situation awareness

Main Article Content

Cinzia Pezzolesi
School of Pharmacy, University of Hertfordshire, Hatfield, UK
Tanya Manser
Fabrizio Schifano
Andrzej Kostrzewski
John Pickles
Harriet Nicholls
Daniel Fishman
Arshad Mubarik
Soraya Dhillon

Abstract

Background: Doctors’ handover has been the subject of investigation since the implementation of the European Working Time Directive in 2004. Little is known regarding handover quality and safety in clinical practice. This study aims to systematically assess handover practice across different clinical settings and to consider its implications for person-centered healthcare.Method: Prospective observational study of handover practice over a period of three weeks in the Obstetrics-Gynaecology, Acute Care Unit and General Surgery departments of one UK General District Hospital. Checklists developed on the basis of the Royal Colleges of Surgeons’ and Physicians’ guidelines were used to assess clinical practice.Results: A total of 306 patients were admitted in the departments during the study period; 45 patients (15%) were not handed over during the change of the shift. Accuracy of handover compared to our gold standard were:  Obstetrics-Gynaecology (45%); Acute Medicine (51%); General Surgery (52%). Information less likely to be handed over was related to patients’ management plan in all specialities. Medicine and Surgery rarely discussed aims and limitations of treatments while Obstetrics-Gynaecology handed over tasks to be done only in 43% of patients. All specialties performed well during the handover of current diagnosis and list of patient problemsConclusions: A number of weaknesses were identified in handover practice across the clinical settings explored. The existing handover process focuses on the current status of patients, whereas safety concerns, time critical actions. Anticipated next steps should address the lack of the so called ‘third level’ of situation awareness as one method aimed at improving the person-centeredness of clinical services.

Article Details

Issue
Vol. 2 No. 2 (2012): June
Section
Regular Articles
Author Biography

Cinzia Pezzolesi, School of Pharmacy, University of Hertfordshire, Hatfield, UK

Research Fellow, School of Pharmacy, University of Hertfordshire, Hatfield, UK

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