Safe use of symbols in handover documentation for medical teams

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008, Sheppard et al. 2008). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research

PATIENT WP4-Deliverable: Curriculum for Handover Training in Medical Education [Public Part]

What is handover? Handover is the accurate, reliable communication of task-relevant information between doctors and patients and from one care-giver to another. This occurs in many situations in healthcare. Why is handover important? Improperly conducted handovers lead to wrong treatment, delays in medical diagnosis, life threatening adverse events, patient complaints, increased health care expenditure, increased length of stay hospital and a range of other effects that impact on the health system(1). This is how accurate performed and well-structured handovers improve patient safety, i.e. “absence of preventable harm to a patient during the process of health care” (2). How to teach handover? The best way to teach practical skills is, to let students perform the skill. To decrease the risk for real patients simulation is the teaching method of choice. Therefore and on the basis of the project’s preceding results (3,4), this curriculum is divided into three modules: Module 1 – Risk and Error Management Module 2 – Effective Communication Module 3 – SimulationPATIEN

The Design, implementation and Evaluation of a Technology Solution to Improve Discharge Planning Communication in a Complex Patient Population

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges. Following a complete assessment of the current discharge planning process, a web-based interactive discharge checklist was designed, implemented and evaluated in the attempt to provide guided communications to the essential partners of the patient’s team in an effort to reduce LOS and readmissions. After a six-month rollout of the new technology and concomitant procedures, the analyses revealed improvement in both the patient’s perception of discharge planning and the ability to discharge patients by noon. Results for LOS and readmission demonstrated inconsistent improvement. The use of an electronic checklist as a communication tool did reduce variability in discharge procedures and provided for continuity in handoff communication between team members. Staff agreed it promoted continuity and improved efficiency

The adaptive capability of the operational team to respond to challenges in the Emergency Centre. A SenseMaker® study in Emergency Centres within Cape Town

Background Emergency centres (ECs) serve as a main entry point for patients into hospitals, and patients that present here are undifferentiated with varying levels of acuity. Uncertainty, interruptions, multiple – often conflicting – priorities, and gaps in information flow are inherent to EC work practices, making it a high-risk environment for operational failure. The EC team, the core of which is formed by doctors and nurses, needs the ability to collaboratively and reliably sense and respond to the constant change and flux of information. This depends on the interactions and sense-making of the EC team. Objectives People give meaning to situations through the process of sense-making; they then subjectively construct their reality and share it via plausible stories regarding their situation and environment. The main objective of this study was to explore the collective team-based sense-making of the operational challenges and decisions within the EC. This interprofessionalstudy focused on the dynamics and negotiations within the EC as a complex adaptive system. Methods This exploratory study used narrative-based inquiry with abductive reasoning to meet the objectives. It was divided into two sections. The first was a thick description of the EC context, daily operations and processes. Then, using the SenseMaker® tool, we captured stories about a situation that stood out to participants, and thus mattered to them. Using this novel method, once they told their story, the storytellers self-analysed their stories within a specially designed framework. The results were then explored to find patterns based on the perspectives of sense-making. Results There is no proof of interprofessional sense-making in the EC, and if it occurs it is due to the informal networks between doctors and nurses, and despite formal structure. There is an operational disconnect between doctors, nurses and management, which is caused by information asymmetry, poor feedback loops and disparate communication channels. Because there is no collective sense-making, the EC team is vulnerable to operational failure and crises. Currently, they respond to operational challenges via quick fixes that result in constant firefighting, the impact of which could be seen by the extensive use of war-related metaphors in their stories

A Guide to the International Mine Action Standards 2010

IMAS are standards issued by the United Nations to guide the planning, implementation and management of mine action programmes. They are a framework for the development of national mine action standards. This handbook contains all IMAS in brief, explains the purpose of the IMAS and the requirements of the different standards in a clear way, serving as a quick reference for mine action practitioners to understand core IMAS issues

Identifying Transfer of Care Gaps: Electronic Health Record Capture of Perioperative Handoff Communications

Transitions in patient care are held together by interdisciplinary handoff communications intended to coordinate the patient\u27s ongoing care requirements. Patients with complexity in care encumber the transfer of care process requiring a higher level of care coordination between the interdisciplinary team (Coleman, 2003; Naylor et al., 2004). While the literature is abundant on the characteristics and quality of handoff communications, it is limited on the requirements of what data is necessary for ongoing care following transfer communications (Galatzan & Carrington, 2018). This dissertation explores the verbal information transferred during Operating Room (OR) to Post Anesthesia Care Unit (PACU) nursing handoff communications and whether the data is captured in the electronic health record (EHR) to represent the information critical to ongoing patient care and care planning. the study builds on the Kennedy Integrated Theoretical Framework (KITF) (Kennedy, 2012) integrating cognition theory, patterns of knowledge theory, and clinical communication space theory to support the human-technology characteristics within perioperative handoffs. Evidence of wisdom was present in the KITF in addition to elements of non-verbal communication patterns emerging from shared common ground contributed to the framework\u27s expansion. to understand the contributions of the perioperative nursing interface terminology, the Perioperative Nursing Data Set (PNDS), makes to postsurgical care transitions, the study examines nursing diagnoses, interventions, interim outcomes and goals relationships to the handoff data communicated between OR and PACU Registered Nurses. Study findings revealed a complex fragmented process of verbal communications and electronic documentation for the handoff process. While the EHR is prominent in data procurement for the handoff process, the design of handoff artifacts (e.g., paper, electronic) significantly impact the value of information received. Incomplete handoff tools or missing EHR data adds to a cycle of information decay while contributing to increase cognitive load and potentiating opportunities for information and knowledge loss. the absence of nursing diagnoses in the automation of the PNDS challenges the integrity of the language within the documentation platform and raises considerations for hierarchical representation within interface terminologies. This study reinforces literature to reconsider user requirements in the design and functionality of healthcare information technology (HIT) to enable data and information flow and preserve knowledge development. the inclusion of mobile technology, cognitive support aids including clinical decision support tools, and other HIT will further enable the effectiveness of transfer communication, knowledge development, and the safety of ongoing patient care

Impact of a Standardized Situation, Background, Assessment, and Recommendation Tool on Satisfaction and Communication in The Perioperative Area

AbstractEffective communication among health care providers is critical to maintain patient safety during the handoff of care. Communication breakdown during handoff can lead to medical errors and sentinel events. The perioperative area is a vulnerable area that is prone to communication errors due to the involvement of providers from various disciplines and the nature of the quick patient turnovers within the perioperative area. To ensure proper communication during the handoff in the perioperative area, a unit-specific handoff tool is required. The focus of the project was to implement a standardized situation, background, assessment, and recommendation (SBAR) communication tool in the perioperative area to be utilized by preoperative area, operating room (OR), and Post Anesthesia Care Unit (PACU) professionals during the handoff, and to evaluate the impact by assessing perceived communication and satisfaction between the OR and the PACU staff. The framework used to support the project was the Iowa Model of Evidence-Based Practice. The participants were trained on a new standardized SBAR handoff and pre- and post- implementation tests were conducted to evaluate the outcome. Descriptive statistics to analyze the comparison surveys found increased satisfaction and improved communication in the perioperative area. The new standardized SBAR can impact positive social change by shifting the culture to a standardized method of handoff communication by empowering the providers to be effective communicators of patient information

First-Responders and Emergency Department Healthcare Provider Interactions During Emergency Situations: A Grounded Theory Study

Interactions between and among first-responders and emergency department (ED) healthcare providers impact the way in which patients are managed during emergency situations. The purpose of this study was to develop a grounded theory to explain the interactions between and among first-responders and ED healthcare providers during emergency situations. Interprofessional collaboration and teamwork has been extensively studied, however little is known about interactions that include first-responders. This study was guided by Strauss and Corbin’s (1990) approach to grounded theory. Data were collected through 256 hours of first-responder and ED observational opportunities and informal interviews with accompanying detailed field notes. As well, in-depth semi-structured interviews were conducted with 15 first-responders and ED healthcare providers. Data were organized using NVivo 10 software. A constant comparative approach consistent with grounded theory was used to analyze the field notes, interview transcripts, and policy documents until theoretical saturation was achieved. The proposed theoretical model, the Interactional Theory of Emergency Response and Care (ITERC), explains the interactions between and among first-responders and ED healthcare providers. Coming together for public safety is the core category that helps to describe the social processes of interactions of first-responders and ED healthcare providers during emergency situations. The four domains or subcategories provide further explanation of the micro, meso, and macro contexts that facilitate and/or impede interactions during emergency response and care. Factors that support first-responders and ED healthcare providers in their coming together for public safety include role clarity, clear communication, IPE, shared policies, and strategies to enhance systems issues such as managing offload delays. Given the importance of interactions between and among first-responders and ED healthcare providers and the effects on public safety, the ITERC may provide a beginning blueprint to guide educators, administrators, and policy makers in planning strategies to enhance the micro, meso, and macro factors influencing emergency response and care