Tribal differences in the post-operative handover

: a mixed-methods study

Abstract

The provision of ultra-safe healthcare relies upon investment in robust systems of work. The transition of care between healthcare providers has been shown to contribute significant risk to patients, so much so that the improvement in handover was listed as one of the top five priorities for the World Health Organisation in 2014. Current handover practices have been evaluated in medicine using numerous techniques on the qualitative – quantitative continuum. The systematic evaluation of published literature revealed a paucity of evidence in relation to the optimal transfer of patient care.

As a consequence, the post-operative handover was evaluated by first undertaking semi-structured interviews of anaesthetic, recovery and surgical staff. Differences of opinion were discovered between professional groups involved in the post-operative handover. These differences have the potential to fuel inter-professional conflict. The handover process was seen as being vulnerable to the effects of outside agencies, with time pressure being most to blame. The post-operative handover was observed and a novel handover intervention was introduced, with the primary objective of reducing multi-tasking and improving information accuracy. The intervention combined education of handover error alongside standardisation of the process. The introduction of a bed-side aide memoire to separate the transfer of equipment from standardised information transfer was introduced with staff involvement.

Prior to the introduction of the handover intervention, core information points such as the patient’s name and allergies were frequently omitted and the process was often beset with distraction from concomitant activities. Both of these factors improved following the introduction of the intervention.

These findings support previous revelations in handover that transitions are frequently not optimised to reduce risk in the patient pathway. However, it is feasible to ameliorate this risk by introducing a low cost quality improvement intervention which aims to standardise what can otherwise be haphazard working practice.

Date of Award	2017
Original language	English
Awarding Institution	University of Dundee
Supervisor	Miles Witham (Supervisor) & Peter McCulloch (Supervisor)