Clinical Handover Communication at Maternity Shift Changes and Women's Safety in Banjul, The Gambia: A Mixed-Methods Study

Background Clinical handover is a vital communication process for patient safety; transferring patient responsibility between healthcare professionals (HCPs). Exploring handover processes in maternity care is fundamental for service quality, addressing continuity of care and maternal mortality.MethodsThis mixed-methods study was conducted in all three maternity hospitals in Banjul, The Gambia. Shift-to-shift maternity handovers were observed and compared against a standard investigating content and environment. Semi-structured interviews and focus group discussions with doctors, midwives and nurses explored handover experience.Results110 nurse/midwife shift-to-shift handovers were observed across all shift times and maternity wards; only 666 of 845 women (79%) were handed over. Doctors had no scheduled handover. Shift-leads alone gave/received handover, delayed [median 35 minutes, IQR 24-45] 82% of the time; 96% of handovers were not confidential and 29% were disrupted. Standardised guidelines and training were lacking.A median 6 of 28 topics [IQR 5-9] were communicated per woman. Information varied significantly by time, high-risk classification and location. For women in labour, 10 [IQR 8-14] items were handed-over, 8 [IQR 5-11] for women classed ‘high-risk’, 5 [IQR 4-7] for ante/postnatal women (p<0.001); >50% had no care management plan communicated.21 interviews and two focus groups were conducted. Facilitators and barriers to effective handover surrounding three health service factors emerged; health systems, organisation culture and individual clinician factors.ConclusionMaternity handover was inconsistent, hindered by contextual barriers including lack of team communication and guidelines, delays, with some women omitted entirely. Findings alongside HCPs views demonstrate feasible opportunities for enhancing handover, thereby improving women's safety.

Clinical handover in a bilingual setting: interpretative phenomenological analysis to exploring translanguaging practices for effective communication among hospital staff

ObjectiveTo explore the linguistic features of translanguaging in bilingual handover practices and elicit the views of hospital staff on factors that hinder or facilitate effective handover practice in a bilingual environment.Methods78 hospital staff were recruited from hospital wards and emergency departments of two Hong Kong hospitals. They were interviewed to determine their perceptions of their handover communication in a bilingual context, and their responses were subjected to interpretative phenomenological analysis.ResultsBased on the staff interviews, three dimensions with potential applications to effective clinical handover are identified. A revised Identify, Situation, Background, Assessment and Recommendation protocol accounting for linguistic pluralism (i.e., the translanguaging process) is suggested to underpin the future research agenda around effective clinical communication in a bilingual context.ConclusionsResearch on handover communication in multilingual contexts is limited. This study outlines linguistic pluralism at the handover stage and details the complexity of handover communication for staff in a bilingual context. It urges for more research with a specific focus on identifying avoidable linguistic issues that emerge from the clinical context and developing a suitable protocol to standardise staff’s translanguaging processes to ensure a safe and efficient handover process in a bilingual environment.

Using lean management approach in improving clinical team leader handover process: nursing services

This report describes the result of the study using lean management approach in improving clinical team leader handover process in nursing services at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East with 511-bed capacity and more than 20 nursing inpatient units. Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another pehealthcare system is a crson or professional group on a temporary or permanent basis. It is in fact a valuable and essential part of the care processes in the hospitals. However, clinical team leaders face a challenging role during handover due to prolonged process, causing extra nursing working hour beyond their 12-hour scheduled shift, resulting in additional burden and exhaustion. The aim of this project was to test the effectivity of the lean management approach in improving the duration of clinical handover by reducing the handover time frame to 50% through eliminating unnecessary steps towards a more efficient, sustainable and effective communication between clinical nursing team leaders. The project results demonstrated the effectiveness and efficiency of the team leader clinical handover process by decreasing the duration by 50%. One hundred per cent of nursing units that were involved in the project were able to start and end their team leader handover process by the average of the selection target of 20–30 min of handover duration.

Factors associated with nurses’ perceptions, their communication skills and the quality of clinical handover in the Hong Kong context

Background Clinical handover is a pivotal, high-risk communicative event because it involves the transfer of responsibility and accountability for patients and their care. Nurses’ perceptions and their communication skills inevitably impact on their ability of clinical handover. Limited studies have explored nurses’ handover practice in the Hong Kong context. This study aimed to identify factors associated with and specific impact paths between the quality, communication skills and nurses’ perceptions on clinical handover. Methods A questionnaire survey was conducted immediately after the nurses’ training in effective handover communication. A convenience sample of 206 bilingual nursing staff from a local hospital in Hong Kong participated in this paper-and-pencil survey adopted from the Nurses Handover Perceptions Questionnaire survey. Results The path analysis revealed that except the opportunity to ask questions and high perceptions of the ISBAR communication protocol, other factors were significantly correlated with improved quality of handover. In addition, nurses who had updated information were likely to ask more questions and obtain a better understanding of the patient care plan during handover. Conclusions The quality of nursing handover depended on the degree of nurses’ grasp of the patient care plan. The ISBAR communication protocol was considered helping nurses to improve their communication skills with other colleagues and indirectly enhance patient’s safety. However, although ISBAR facilitated nurses to structure clearer handover communication, it was not the most important predictive factor for determining handover quality.

Impact of Structured Clinical Handover Protocol on Communication and Patient Satisfaction

The Handover process is an essential aspect of patient care in daily clinical practice to ensure continuity of patient care. Standardization of clinical handover may reduce sentinel events due to inaccurate and ineffective communication. Single arm experimental trial was conducted to assess the effect of standard Situation, Background, Assessment, Recommendation (SBAR) protocol implementation in overall bedside nursing handover process, patient satisfaction, and nurses’ acceptance. As a sample, all nursing staff of specified unit, all handover process performed by them, and patients admitted during study the period were included. Initially, the prevailing handover process and patient satisfaction regarding nursing handover was assessed using a structured observation checklist. During the implementation phase, nurses were trained on an SBAR handover protocol. After implementation, nursing handovers were again assessed and data regarding patient satisfaction and nurses’ acceptance were collected. There was a statistically significant difference ( P < .05) in median scores between the pre and post-intervention group on overall nursing handover and patient satisfaction regarding nursing handover. Standardization of patient’s handover process is effective in terms of improving nursing handover process, patient satisfaction, and health professionals’ acceptance.