Emergency Care Handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history

Abstract

BackgroundInadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations. This paper explores both what is communicated (content) and how this is communicated (verbal behaviours) during different types of handover conversations across care boundaries in emergency care.MethodsThree types of interorganisational (ambulance service to emergency department (ED) in ‘resuscitation’ and ‘majors’ areas) and interdepartmental handover conversations (referrals to acute medicine) were audio recorded in three National Health Service EDs. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis.Results203 handover conversations were analysed. Handover conversations involving ambulance services were predominantly descriptive (60%–65% of utterances), unidirectional and focused on patient presentation (75%–80%). Referrals entailed more collaborative talk focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%–5% of handover conversation content related to the patient's social and psychological needs.ConclusionsHandover may entail both descriptive talk aimed at information transfer and collaborative talk aimed at joint decision-making. Standardisation of handover needs to accommodate collaborative aspects and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.

Human factors challenges for the safe use of artificial intelligence in patient care

“…Handover is a well-recognised safety critical task in the delivery of care, although in traditional conception, we think of handover between clinicians or teams of clinicians 26. In the future, handover between humans and autonomous AI systems will become increasingly important, and one might assume that this will be even more complex than the handover between the autopilot and the driver of an autonomous vehicle.…”

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“…When the term MIST is used, it requires other complementary data such as temperature, categorization of the elements of the Glasgow scale, important medications and allergies (15) . Likewise, the term ATMIST, which is widely used in guidelines related to resuscitation in the United Kingdom, must be accompanied by psychosocial aspects (20) . In addition, it is necessary to standardize the processes, in which the terms AMPLE and ABCDE are inserted in the protocols, given the positive correlation of satisfaction between professionals when these terms were used and when the transfer process was structured (15) .…”

“…The lack of leadership identification was also a problem identified (16)(17)(18)(19)(20)(21) , in relation to which a study with 12 nurses showed the need to clearly identify to whom the case will be reported, since this is also a process of transferring responsibilities and essential Chart 1 (concluded) of for the continuity of care (16) . It is also pointed out that medical professionals of some specialties accept only patients who meet highly specific criteria, which can overburden the emergency department and lead to delays in care (21) .…”

“…Emergency Care Handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history (20)…”