Clinical handover
Clinical handover refers to the process of transferring professional responsibility for a patient's care from one healthcare provider to another. This transition can be temporary or permanent and may involve various patients and professionals. Effective clinical handover is crucial to ensure continuity of care and to avoid medical errors, which can arise from issues such as incomplete medical records or miscommunication about treatment plans. Common scenarios for clinical handover include shift changes among nursing staff, transitions between different departments, and patient discharges to other facilities.
Factors that can impede effective handover include staff workload, communication barriers, and hierarchical structures within healthcare settings. Various methods facilitate clinical handover, including verbal, written, and electronic reporting. Bedside handovers, which involve patients in the discussion, can enhance communication but may also present challenges such as time constraints and patient preferences. Best practices for clinical handover have been identified through research in multiple countries, emphasizing the importance of clear communication about the patient's condition, follow-up care, and medication management. Given the complexity of patient care transitions, robust handover processes are essential for improving patient safety and outcomes.
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Subject Terms
Clinical handover
Clinical handover is the transfer of professional responsibility for some or all aspects of patient care to another. This handover may be temporary or permanent and may involve multiple patients and professionals. Professional responsibility includes accountability, responsibility, and information about care and condition. Workload, communication styles, fatigue, and hierarchies are among factors that hinder clinical handover.
Overview
Clinical handover generally occurs as a handoff, also known as handover, shift report, sign-out, and sign-over, usually as part of a shift change—for example, when nurses on one hospital shift prepare to leave while the nurses on the next shift prepare to take over patient care. Other examples include handoffs between nursing units or settings (such as emergency room and operating room), handoffs between physicians, and handoffs involving patient discharge or transfer to another facility.
Many medical mistakes have been attributed to poor handoff. For this reason, a number of countries, including the United States, Australia, and Great Britain, have studied the topic and established best practices for clinical handover. Concerns include communication about condition, follow-up care, and medication. Errors may range from transferring a patient with incomplete medical records, which may delay proper care or result in prescription errors, to operating on the wrong body part, which may result in death or permanent disability.
Clinical handover requires communication. This is achieved in an open and accepting environment—for example, a hospital in which less-experienced staff are encouraged to ask questions, and experienced staff willingly share information. Methods may include electronic, verbal, or written reports; bedside handovers, which include the patient in the discussion; and telephone handovers. These methods have strengths and weaknesses. For example, a verbal bedside report includes the patient, who can correct erroneous information and ask questions; however, information conveyed verbally may be forgotten, and the patient may not understand medical terms. Bedside reports are time consuming, and some patients may not wish to participate. A written report, however, may not give care providers and patients an opportunity to ask questions. A medical facility, therefore, may require both a verbal and written report in a clinical handover. Such handovers have been cited by emergency department staff as a good opportunity for two health care providers to evaluate a situation and possibly discover unrecognized problems, which improves patient care.
According to Friesen et al. in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, the most effective clinical nursing handover method uses both a preprinted sheet of patient information and a verbal report. Participants retained between 96 and 100 percent of information. The second-most effective was note taking and verbal reporting, with information retention between 31 and 58 percent. A verbal-only method of handover resulted in retention between 0 and 26 percent.
Clinical handovers are especially important when patients are transferred between facilities, such as when a patient is discharged from a hospital and transferred to a rehabilitation center. Information is usually shared in written records, which may be lost in travel. The facilities and staff often have no professional interaction, which makes asking questions impossible or at least very difficult. Discharge planning is also important because follow-up care must be communicated to the patient, caregivers, and other medical professionals. Communication related to medication has been found to contribute to many adverse outcomes following discharge.
Bibliography
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