Can health facilities achieve handover effectiveness?

Ineffective handover has been identified by the Royal College of Physicians (RCP) as being a "major preventable cause of patient harm" .The risks associated with inadequate handover include information not being handed over or being misunderstood which may lead to "serious breakdowns in the continuity of care, inappropriate treatment, and potential harm to the patient".

According to CMPA a handover is the transfer of responsibility and accountability for some or all aspects of care for a patient or group of patients, on a temporary or permanent basis. It entails appropriately transferring information to help deliver safe care.

Elements of a handover

The information transferred depends on the clinical circumstances, and may include the:

• clinical condition

• status of investigations and treatments

• likely clinical course

• possible problems and consideration of strategies should problems arise and

• responsibility for ongoing care

As appropriate, the handover process should include opportunities to discuss the meaning of the information, seek clarification and ask questions.

Let’s look at an example of a poor handover. Mr X is a 75 year old male who has come into the hospital with acute confusion and shortness of breath. He is seen in casualty by the clinical team on the late shift. By the time Doctor Y is leaving, only his liver function tests are back. His portable CXR was unremarkable. His full blood count, CRP and U/Es are outstanding. The radiographer covering CT has been busy so CT is booked but not completed. Dr Y asks his colleague, Dr Z coming onto the night shift to chase these up before the patient is transferred on the ward. He had difficult veins so he has no access. Dr Z also needs to put in the venflon. Unfortunately, there is already a patient in resus and Dr Z doesn’t get a chance to write this down. It is a busy night in casualty and Dr Z is run off his feet so does not get round to seeing Mr X. The nurse decides to move him to the ward as they are now running out of beds in casualty. It is quieter on the wards and the casualty nurse decides to ask the ward doctor to chase up the patient. However, the ward doctor is doing a procedure and can’t be reached. The ward nurse leaves a note for the ward doctor in the book but the procedure takes a few hours. Mr X lies on the ward with a rip roaring infection and acute kidney injury and is not seen until the next day. He is now very confused with a worsening GCS. An emergency CT is done and he has an intracranial haematoma. Can you identify the various points where effective handover would have made a difference?

Various ways of doing handovers

There are currently many different handover methods being used in health facilities. Often, a verbal handover is conducted, either by telephone or in person, where the recipient of the handover may or may not take note or refer to over the course of his shift.

Some groups arrange for a handover book or folder to be used so that the team can leave messages about patients or particular concerns. 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. 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.

Outcome of poor handovers

The effectiveness of handovers will depend on the timeliness, accuracy and completeness of the information given, and whether it is understood by your colleagues. Inconsistent processes, absence of best practice guidelines and limited use of protocols mean that handovers can be fraught with risk. Poor handovers can result in adverse events, avoidable harm and complaints. They can be associated with: 

• Inaccurate clinical assessment and diagnosis

• Delays in diagnosis and treatment

• Delays in ordering investigations

• Medication errors

• Inconsistent or incorrect translation of results

• Duplication of investigations

• Increased length of stay

• Increased in-hospital complications and

• Low patient satisfaction.

SBAR Handover format

The Situation, Background, Assessment & Recommendation (SBAR) handover format was originally developed by the United States military for communication on nuclear submarines, but has been successfully used in many different healthcare settings, particularly relating to improving patient safety through ensuring adequate and complete patient handovers.

SBAR is an easy to use technique that provides a framework for communication between members of the health care team about a patient's condition. It enables information to be transferred accurately between individuals.

• S = Situation (a concise statement of the problem)

• B = Background (pertinent and brief information related to the situation)

• A = Assessment (analysis and considerations of options — what you found/think)

• R = Recommendation (action requested/recommended — what you want)

Healthcare facilities that use a tool with the SBAR format have great inter-team communication and collaboration. There is also improved patient care and safety.

Conclusion

When patient information is handed over by the verbal, handover book or folder method, very few facts are retained; therefore, this method should be avoided whenever possible.

However, as seen above the SBAR format is highly efficient and even more so if it is on a platform that allows for the handover to be regularly updated as all the information is retained.

Visit Medixus to start your free trial of our SBAR Handover tool