The handover room: a qualitative enquiry into the experience of morning clinical handover for acute medical teams

Abstract

Background Effective clinical handover has always been integral to delivering safe, high‐quality care in medical wards. Aim As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research. Methods Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio‐recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection. Results There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities. Conclusion This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time‐sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability.

Facilitating educational experiences in a paediatric handover: A qualitative case study

“…3 Leadership qualities, such as flexibility and sensitivity, are regarded as crucial within handover. 14 Our study demonstrates that the role of the handover and educational leader is often adopted by the most senior members of the team, and this was acknowledged by all participants regardless of clinical seniority. Clinical hierarchy and team culture were found to contribute to overall team dynamics, and were augmented by verbal and non-verbal modes of communication, supporting findings of previous studies.…”

“…Leadership qualities, such as flexibility and sensitivity, are regarded as crucial within handover 14 . Our study demonstrates that the role of the handover and educational leader is often adopted by the most senior members of the team, and this was acknowledged by all participants regardless of clinical seniority.…”

“…Donnelly et al . previously reported the significance of structural issues such as a start time, a sequence and checklist for handover contributing to the efficiency of an acute medical handover 14 . Our study proposes the need to also consider the physical setting in which handover occurs, to optimise and create a positive learning environment.…”

“…Recent studies have established the opportunity for education within handover in various settings, while recognising the priority of ensuring the safe and effective transfer of patient information. 7,13,14 This study investigated this notion further, exploring the nuances that contribute towards education within a handover and identified facilitators and barriers from a multi-level perspective.…”

“…Donnelly et al previously reported the significance of structural issues such as a start time, a sequence and checklist for handover contributing to the efficiency of an acute medical handover. 14 Our study proposes the need to also consider the physical setting in which handover occurs, to optimise and create a positive learning environment. These include attention to accessible seating arrangements, availability of appropriate equipment and all individuals having a handover sheet to encourage engagement and a sense of team inclusivity.…”