Improving actual handover behavior with a simulation-based training intervention

Abstract

A simulation-based training intervention to improve patient handovers between anesthesia providers (APs) and Post-Anesthesia Care Unit (PACU) nurses (RNs) in adult (VUH) and pediatric (VCH) PACUs, was developed, implemented, and evaluated. The intervention included didactic webinars, an electronic handover report tool, a 2-hour simulation-based training session and a 1-hr “refresher” course several months later. Training focused on interpersonal skills and overcoming obstacles to effective handovers. Trained nurses observed and evaluated 981 actual PACU handovers over 12 months using a standardized rating tool. A different blinded observer scored pre- and post-training simulated handovers. A culture survey was administered before and after the intervention. After training, handover quality improved significantly with more than 70% of handovers rated as “effective” in both PACUs (P<0.001). The training status of the handover giver (AP) was the critical determinant of handover effectiveness. Following full implementation, new (untrained) clinicians performed effective handovers suggesting culture change and/or implicit training.

Handover of patients: a topical review of ambulance crew to emergency department handover

“…Inter‐ and multi‐professional education holds the possibility to enhance mutual understanding and a change in culture in a team, convincing personnel that optimizing the handover can attain important gains in patient safety, as well as attain a common understanding between ambulance and ED personnel. Multimodal training programmes have shown to improve structure in handover between residents and nurses in a post‐operative care unit, but so far no reports on improved outcome for patients in the ED handover have been published . Additionally, a sustained change was seen in handovers even in new staff members who were not trained …”

“…Multimodal training programmes have shown to improve structure in handover between residents and nurses in a post‐operative care unit, but so far no reports on improved outcome for patients in the ED handover have been published . Additionally, a sustained change was seen in handovers even in new staff members who were not trained …”

Team Communication During Patient Handover From the Operating Room

“…A notable exception is one complex, multicomponent intervention (Weinger et al, 2010). Most interventions have been evaluated only on the basis of adherence to protocols and error rates.…”

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

“…The findings, which support the association between specific handover strategies, errors and handover quality, suggest the integration of flexibility alongside standardized procedures. First, to ensure that incoming nurses play a more active role in handovers, training interventions should be developed aimed at teaching incoming nurses strategies to speak up and make sure that they receive the information they need (Weinger et al 2010, Manser et al 2013. A more radical option might be to structure handovers differently, by allowing the incoming nurse to lead the handover through a three-stage process: reading the written report, receiving an impression of the patient and asking the outgoing nurse for additional information.…”