Towards an understanding of the information dynamics of the handover process in aged care settings - A prerequisite for the safe and effective use of ICT

BACKGROUND Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. PURPOSE The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. METHODS The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. RESULTS Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I "Information gathering by RN", HOP II "Preparation of preliminary handover sheet" and HOP III "Execution of handover meeting". Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. CONCLUSION By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

[1]  David G. Kemp,et al.  eHand-offs: An IBM® Lotus® Domino® Application for Ensuring Patient Safety and Enhancing Resident Supervision in Hand-Off Communications , 2006, AMIA.

[2]  Suzanne Bakken,et al.  Applying an Evaluation Framework for Health Information System Design, Development, and Implementation , 2006, Nursing research.

[3]  Alissa L. Russ,et al.  Exploring the persistence of paper with the electronic health record , 2009, Int. J. Medical Informatics.

[4]  Hardeep Singh,et al.  Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. , 2007, Archives of internal medicine.

[5]  C. Jorm,et al.  OSSIE guide to clinical handover improvement , 2010 .

[6]  M. Stommel,et al.  Clinical Research: Concepts and Principles for Advanced Practice Nurses , 2003 .

[7]  Jenelle Matic,et al.  Review: bringing patient safety to the forefront through structured computerisation during clinical handover. , 2011, Journal of clinical nursing.

[8]  E. Bass,et al.  Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey , 2008, Quality & Safety in Health Care.

[9]  Vimla L. Patel,et al.  To err is not entirely human: Complex technology and user cognition , 2005, J. Biomed. Informatics.

[10]  L Eastes,et al.  Use of the personal digital assistant for point-of-care trauma documentation. , 2001, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[11]  Andrew Georgiou,et al.  Review Paper: The Impact of Mobile Handheld Technology on Hospital Physicians' Work Practices and Patient Care: A Systematic Review , 2009, J. Am. Medical Informatics Assoc..

[12]  Gary B. Shelly,et al.  Microsoft Office , 1995 .

[13]  Debra F. Weinstein,et al.  Residents report on adverse events and their causes. , 2005, Archives of internal medicine.

[14]  Saturnino Luz,et al.  Fieldwork for requirements: Frameworks for mobile healthcare applications , 2010, Int. J. Hum. Comput. Stud..

[15]  Ashley Edwards,et al.  Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings , 2009, Int. J. Medical Informatics.

[16]  Christopher Beach,et al.  Profiles in patient safety: emergency care transitions. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[17]  M. Sheelagh T. Carpendale,et al.  InfoFlow Framework for Evaluating Information Flow and New Health Care Technologies , 2010, Int. J. Hum. Comput. Interact..

[18]  Carl Fernandes,et al.  Electronic software significantly improves quality of handover in a London teaching hospital , 2009, Health Informatics J..

[19]  Alex Till,et al.  Safe Handover : Safe Patients – The Electronic Handover System , 2014, BMJ quality improvement reports.

[20]  K. Yee,et al.  “HAND ME AN ISOBAR”: a pilot study of an evidence‐based approach to improving shift‐to‐shift clinical handover , 2009, The Medical journal of Australia.

[21]  T. Brennan,et al.  Does Housestaff Discontinuity of Care Increase the Risk for Preventable Adverse Events? , 1994, Annals of Internal Medicine.

[23]  Kevin Andrews,et al.  National strategy for an ageing Australia: an older Australia, challenges and opportunities for all , 2001 .

[24]  Paul Turner,et al.  Socio-cultural issues and patient safety: a case study into the development of an electronic support tool for clinical handover. , 2007, Studies in health technology and informatics.

[25]  David A K Watters,et al.  Electronic medical handover : towards safer medical care , 2022 .

[26]  Anne M. Tomolo,et al.  Conceptualizing handover strategies at change of shift in the emergency department: a grounded theory study , 2008, BMC health services research.