Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital

Abstract

Background Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting. Objective To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital. Methods JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration. Results Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration. Conclusions Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.

Improving postoperative handover from anaesthetists to non-anaesthetists in a children’s intensive care unit: the receiver’s perception

“…(17) Even in standard face-to-face handover systems, communication challenges can still occur if the transfer of care is not smoothly executed. (3,8,18,19) Many studies that evaluated handover processes reported that interruptions, environmental factors (e.g. noise, crowding) and specifi c patient care requirements for both groups of staff involved in the handover resulted in an unstructured and error-prone handover process; (9,15,20) this is similar to the fi ndings of the present study.…”

“…This scenario could be due to senior PIs' preference for conveying patient information at a face-to-face handover instead of via written communication, and points to the need for a communication form that guarantees compliance even among senior staff. (8,21) Communication improved not only as a result of changes in the content of the SBAR handover document, but also in the use of the document during face-to-face handover to relay its content ('timeout'); the latter was a requirement of the new PETS handover protocol. Therefore, our results differed from Joffe et al's, (22) as our recipients appreciated the use of the SBAR handover document as a format for face-to-face verbal handover and as a reference for other CICU caregivers who did not participate in the actual handover.…”

“…(3) Over the years, various handover techniques have been established to provide continuity of patient care during change of shift, (4) interdisciplinary referral, (4,5) postsurgical care from the OT to ICU (6) and ward transfer of a patient. (7) Techniques such as narrative face-to-face communication, (3,8) standardised protocols, (1,2,5) and written documents (1,2) have been used in the handover process. In many institutions worldwide, handover documents have been shown to be a useful tool in the process, as they maximise communication during the handover.…”

“…(2,6) Optimal effi ciency for patient safety has been achieved by adopting communication mnemonics such as SBAR (situation, background, assessment, recommendations) for handover documentation and communication patterns. (8,9) At KK Women's and Children's Hospital (KKH) in Singapore, handover from the OT, by outgoing anaesthetists to the paediatric intensivists (PIs) and nurses in charge of the children's intensive care unit (CICU), comprises verbal face-to-face communication and an SBAR handover document. Upon arrival in the CICU, the anaesthetist discusses the intraoperative events that are signifi cant for initial management of the patient in the CICU, the surgeon provides surgical details and advice on patient care, while the anaesthetic unit nurse passes on the patient's particulars to the CICU nurse.…”

Handoffs: Transitions of Care for Children in the Emergency Department

“…33 Other recommendations to improve the ToC process include training sessions, senior supervision, and the use of electronic aids. 34 The following 5 principles reflect effective ToCs 23 :…”