Does clinical handover promote situation awareness? : Implications for person-centered healthcare

Abstract

Background: Doctors’ handover has been the subject of investigation since the implementation of the European Working Time Directive in 2004. Little is known regarding handover quality and safety in clinical practice. This study aims to systematically assess handover practice across different clinical settings and to consider its implications for person-centered healthcare. Method: Prospective observational study of handover practice over a period of three weeks in the Obstetrics-Gynaecology, Acute Care Unit and General Surgery departments of one UK General District Hospital. Checklists developed on the basis of the Royal Colleges of Surgeons’ and Physicians’ guidelines were used to assess clinical practice. Results: A total of 306 patients were admitted in the departments during the study period; 45 patients (15%) were not handed over during the change of the shift. Accuracy of handover compared to our gold standard were: Obstetrics-Gynaecology (45%); Acute Medicine (51%); General Surgery (52%). Information less likely to be handed over was related to patients’ management plan in all specialities. Medicine and Surgery rarely discussed aims and limitations of treatments while Obstetrics-Gynaecology handed over tasks to be done only in 43% of patients. All specialties performed well during the handover of current diagnosis and list of patient problems Conclusions: A number of weaknesses were identified in handover practice across the clinical settings explored. The existing handover process focuses on the current status of patients, whereas safety concerns, time critical actions. Anticipated next steps should address the lack of the so called ‘third level’ of situation awareness as one method aimed at improving the person-centeredness of clinical services.