Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

© 2017 Australian College of Critical Care Nurses Ltd. Introduction: There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. Objectives: The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. Methods: The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. Results and discussion: A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Conclusion: Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover

On the Minimization of Handover Decision Instability in Wireless Local Area Networks

This paper addresses handover decision instability which impacts negatively on both user perception and network performances. To this aim, a new technique called The HandOver Decision STAbility Technique (HODSTAT) is proposed for horizontal handover in Wireless Local Area Networks (WLAN) based on IEEE 802.11standard. HODSTAT is based on a hysteresis margin analysis that, combined with a utilitybased function, evaluates the need for the handover and determines if the handover is needed or avoided. Indeed, if a Mobile Terminal (MT) only transiently hands over to a better network, the gain from using this new network may be diminished by the handover overhead and short usage duration. The approach that we adopt throughout this article aims at reducing the minimum handover occurrence that leads to the interruption of network connectivity (this is due to the nature of handover in WLAN which is a break before make which causes additional delay and packet loss). To this end, MT rather performs a handover only if the connectivity of the current network is threatened or if the performance of a neighboring network is really better comparing the current one with a hysteresis margin. This hysteresis should make a tradeoff between handover occurrence and the necessity to change the current network of attachment. Our extensive simulation results show that our proposed algorithm outperforms other decision stability approaches for handover decision algorithm.Comment: 13 Pages, IJWM

A survey of handover algorithms in DVB-H

Digital Video Broadcasting for Handhelds (DVB-H) is a standard for broadcasting IP Datacast (IPDC) services to mobile handheld terminals. Based on the DVB-T standard, DVB-H adds new features such as time slicing, MPE-FEC, in-depth interleavers, mandatory cell id identifier, optional 4K-modulation mode and the use of 5 MHz bandwidth in addition to the usually used 6, 7, or 8 MHz raster. IPDC over DVB-H is proposed for ETSI to complement the DVB-H standard by combining IPDC and DVB-H in an end-to-end system. Handover in such unidirectional broadcasting networks is a novel issue. In the last few years since the birth of DVB-H technology, great attention has been given to the performance analysis of DVB-H mobile terminals. Handover is one of the main research topics for DVB-H in mobile scenarios. Better reception quality and greater power efficiency are considered to be the main targets of handover research for DVB-H. New algorithms for different handover stages in DVB-H have been the subject of recent research and are currently being studied. Further novel algorithms need to be designed to improve the mobile reception quality. This article provides a comprehensive survey of the handover algorithms in DVB-H. A systematic evaluation and categorization approach is proposed based on the problems the algorithms solve and the handover stages being focused on. Criteria are proposed and analyzed to facilitate designing better handover algorithms for DVB-H that have been identified from the research conducted by the author

Reconceptualising clinical handover: Information sharing for situation awareness

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Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO) : primary research

Background and objectives: Handover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover. Methods: Three NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways. Results: Handover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows. Conclusions: The research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued

Safer clinical systems : interim report, August 2010

Safer Clinical Systems is the Health Foundation’s new five year programme of work to test and demonstrate ways to improve healthcare systems and processes, to develop safer systems that improve patient safety. It builds on learning from the Safer Patients Initiative (SPI) and models of system improvement from both healthcare and other industries. Learning from the SPI highlighted the need to take a clinical systems approach to improving safety. SPI highlighted that many hospitals struggle to implement improvement in clinical areas due to inherent problems with support mechanisms. Clinical processes and systems, rather than individuals, are often the contributors to breakdown in patient safety. The Safer Clinical Systems programme aimed to measure the reliability of clinical processes, identify defects within those processes, and identify the systems that result in those defects. Methods to improve system reliability were then to be tested and re-developed in order to reduce the risk of harm being caused to patients. Such system-level awareness should lead to improvements in other patient care pathways. The relationship between system reliability and actual harm is challenging to identify and measure. Specific, well-defined, small-scale processes have been used in other programmes, and system reliability has been shown to have a direct causal relationship with harm (e.g. care bundle compliance in an intensive care unit can reduce the incidence of ventilator-associated pneumonia). However, it has become evident that harm can be caused by a variety of factors over time; when working in broader, more complex and dynamic systems, change in outcome can be difficult to attribute to specific improvements and difficulties are also associated with relating evidence to resulting harm. The overall aim of Phase 1 of the Safer Clinical Systems programme was to demonstrate proof-of-concept that using a systems-based approach could contribute to improved patient safety. In Phase 1, experienced NHS teams from four locations worked together with expert advisers to co-design the Safer Clinical Systems programme

Handover Necessity Estimation for 4G Heterogeneous Networks

One of the most challenges of 4G network is to have a unified network of heterogeneous wireless networks. To achieve seamless mobility in such a diverse environment, vertical hand off is still a challenging problem. In many situations handover failures and unnecessary handoffs are triggered causing degradation of services, reduction in throughput and increase the blocking probability and packet loss. In this paper a new vertical handoff decision algorithm handover necessity estimation (HNE), is proposed to minimize the number of handover failure and unnecessary handover in heterogeneous wireless networks. we have proposed a multi criteria vertical handoff decision algorithm based on two parts: traveling time estimation and time threshold calculation. Our proposed methods are compared against two other methods: (a) the fixed RSS threshold based method, in which handovers between the cellular network and the WLAN are initiated when the RSS from the WLAN reaches a fixed threshold, and (b) the hysteresis based method, in which a hysteresis is introduced to prevent the ping-pong effect. Simulation results show that, this method reduced the number of handover failures and unnecessary handovers up to 80% and 70%, respectively