A video analysis of clinical handovers between ambulance services and emergency departments

Abstract

This thesis examines how clinical handovers between ambulance and emergency services were conducted. Clinical handovers are an exchange of patient information and responsibility from one healthcare team to another. They have been a key area of concern due to potential patient safety issues arising through non-technical human factor skills of communication and teamworking. However, there remains a lack of research that has examined clinical in the context of multidisciplinary settings. To redress this gap in knowledge this thesis adopted a video analysis methodology of pre-existing handover videos. Data was derived from television programs and provided naturally occurring instances of handovers being conducted. The video analysis approach was underpinned by conversation analysis, which allowed an examination of interactional features used by team members to structure handover activity. The three analytical chapters that make up this thesis how the handover activity was carried out: 1) the clinical handover structure, 2) epistemic knowledge claims, and 3) embodied actions. Overall the findings illustrated the different conversational tools used by interdisciplinary team members which shaped how information was communicated. It showed how speakers would use resources to develop engagement during discussions that aided the handover process. This showed that the handover went beyond a structured institutionally derived activity, but one shaped by the interactants. This thesis has added to the knowledge of how the interactional order of clinical handovers predominate irrespective of the continuous attempts to standardize the activity. These findings showed how handovers are carried out through an analytical lens of “work as done” rather than “work as imagined” providing understandings that can inform practice and shape future research directions