Improving Clinical Handover
Tina Kendrick / Dr Jeanette Marchant
NSW Newborn and paediatric Emergency Transport Service, Sydney, Australia, School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Australia, Emergency Department, The Children's Hospital at Westmead, Westmead, Australia
Tina is the Clinical Nurse Consultant – Paediatrics at NETS NSW and a Clinical Lecturer and doctoral student at the University of Tasmania. Tina has been practicing, teaching and researching in paediatrics and critical care for the past three decades. She has co-authored book chapters and journal articles on critically ill children, critical care nurse practice standards, credentialing for specialist critical care nurses, and transition to specialty practice. Tina’s current projects are focussed on bronchiolitis, humidified high flow oxygen therapy in infants and children, clinical handover and use of the paediatric index of mortality (PIM) in the retrieval setting.
Clinical handover was identified throughout NSW as a root cause of major healthcare incidents and mandated for change. Handover is fundamental for decision-making in retrieval where direct clinical contact is not possible. A single retrieval often involves multiple handovers. It is therefore essential that accurate information is exchanged in a systematic and coordinated way. This minimises risk of error from poor communication and enhances safe, timely transfer of clinical care. Published work on optimising handover in retrieval is sparse.
NETS NSW is the dedicated retrieval service for newborns and children in NSW and the ACT. Our project aim was to standardise and improve clinical communication during handover.
The project was conducted in four phases: data gathering from focus groups and observations of both referring and retrieval staff handovers; tool development; implementation of tools; and evaluation.
Focus groups revealed retrieval clinicians experienced inadequate handovers from referring clinicians during the initial call to NETS when retrieval decisions are made. Inexperienced and junior clinicians called NETS with limited patient information, rarely used a structured handover tool, and had no guide for information NETS required. When conferencing with receiving units prior to team departure, identified problems included multiple handovers as shifts changed, with new accepting clinicians.
Direct observation at receiving units found NETS handovers were structured and timely. Challenges observed in both referring and receiving units included: environmental noise, delays waiting for senior clinicians to attend handover, interruptions, delays awaiting patient documentation and unstructured handovers.
Findings from focus groups and handover observations were used to develop: 1) a NETS handover guideline. 2) ISBAR as the handover format. 3) a standardised triage form for NETS staff specialists and 4) a proforma for referring hospital clinicians. Post-implementation focus groups and observations of handover are planned. Electronic medical record development presents new opportunities for online handover resources.