Significance of the Project

The landscape in the healthcare in Australia have evolved to a tremendous level to cater to needs of the patients. The healthcare professionals today have to modify the healthcare systems according to the needs of the patients to ensure round the clock safety of the latter. The professionals like the nurses and doctors have to handover the responsibility of care of the patients to their next counterparts. Communication plays a tremendously important role in ensuring effective clinical handover before the healthcare staff members (Williams, 2018). This is because clinical handover involves exchange of medical information and accountability to the next professional in the shift. Improper handover can result in deterioration in the health condition or even death of the patients. This risk posed by clinical handover onto the patients have led to countries like the United Kingdom and Australia pass laws to ensure effective handover of clinical responsibilities from staff members of one shift to the staff members of the next shift. Effective communication in clinical handover are not restricted to the medical staff members alone but also encompass the senior medical staffs as well, if required to ensure physical wellbeing of the patients. The medical staff holding higher levels in the hierarchy are entrusted with the responsibility of ensuring effective clinical handover between staff members of two successive shifts. The medical facilities like hospitals today use computerised records of clinical handover to ensure smooth transfer of responsibilities. These effective communication regarding clinical handover has proved to be of great value in Australia which boasts one of the most advanced healthcare environment in the world (Safetyandquality.gov.au, 2018). The paper would delve into this role of effective communication to ensure effective clinical handover to ensure security and wellbeing of the patients.

The Australian resource centre for healthcare innovation was contracted by the Australian council for quality and safety in Health Care for offering a standard operating protocol that is necessary for the taking part in world’s health organisation. However, improved longevity and changing lifestyle are putting huge pressures on the all the healthcare systems around the world.

Hospitals settings therefore, needs to manage rapidly growing number of patients who are increasingly present with the complicated chronic condition. To improve these chronic situation of the patient, clinical handover is necessary in medical care settings. In this context, clinical handover refers to the transfer of the professional responsibility and accountability for all the required aspects of care provision for the patient to another individual on a temporary basis.

However, due to changing conditions of work in health care settings clinical handover has become a necessary task. The Australian national safety and Quality health service standards offers the external criteria in different care settings to evaluate the practise. In order to avoid and reduce errors in communication and treatment of the patients, clinical handover is important to understand in all healthcare settings.

The main aim of the project is to evaluate the effectiveness of communication taking place through clinical handover in health care settings. Based on this the study has investigated the emerging activities of clinical handover and existing trends in health and communication method that influences on the service user.

Aim

All the designs and method of the project have been conducted through integrative and rapid review of literature using various electronic database such as CINAHL, SCOPUS, and COCHRANE library. The project has been performed through comprehensive literature search through rapid reviews using multiple bibliographic electronic databases. Grey literature was searched in a thorough way and the health technology evaluation based on clinical handover were surveyed to recognise the additional review of the literature.

However, detailed data has been collected from the literature review and reporting sources that are close to the rapid review search strategies. In this regards, the quality of conduct and reporting of rapid review have been evaluated using the A measurement Tool to analyse the systematic (AMSTAR) and preferred reporting items that are necessary for required for systemic reviews. Therefore, compliance with each of checklist was effectively examined with the sum of reported items in the systematic review to illustrate the overall compliance.

Background and literature

Organisational cultural factors

Communication is the process of cooperation that usually has four major elements including sender, the message, the recipients and the feedback. However, Anderson et al., (2015) stated that communication is highly influenced owing to personal feelings and those can be framed by the organisational culture. Therefore, it is essential within the organisational context that communication is considered while framing process of clinical handover. The studies in this context are limited.

As stated by Peter et al., (2015), improved longevity and changing lifestyles are putting increased pressures on the operations of clinical settings. Therefore, it is increasingly becoming essential for hospitals to manage the growing number of service users, which are growingly present with the complicated co morbidities and chronic situation.

However, one of the indicators of these increasing pressures is due to the high percentage of avoidable service harm in hospitals that accounts to almost 10% in the establishing countries, and that is potentially higher in the developing countries. However, it has been estimated from various sources that Australia alone has almost 500,000 people who suffered from unavoidable treatment in hospitals (Williams, 2018).

Therefore, ineffective communication is now increasingly well identified contributor for preventing patient centred harm taking place hospitals.  According to Ding et al., (2016), for certain period time research suggested that clinical handover is a critical site for managing communication issue, for instance, a current large-scale European Commission project reported that handover in clinical communicable is accountable for almost 25% to 40% of dangerous events in hospital settings (Abraham et al., 2014).

Estimates in this context shows that number of clinical handovers in Australia is more than 40 million and in USA it is more than 300 million representing that handover is arguably the most frequently used communication process in between health care employees and in delivery of patient oriented care.

On the contrary, Sassoli & Day (2017) argues that lack of communicative data within clinical care settings may make it impossible to demonstrate the practical as well as standardised handover protocols. Data in this context shows that contextual issues of hospital settings often helps to resolve against effective communication thereby compromising over the clinical Handover (Yu & ja Kang, 2017). For the purpose of clinical handovers, healthcare members and managers are required to manage the major contextual factors of participants, planning, and resources as well as organisational environment. Failure to manage these areas may amount to insufficient tolerance to risky issues.

Designs

Clinical handover and patients’ health risk management:

Clinical handover in appropriate ways plays a significant role in ensuring safety of patient and the physical wellbeing of the latter. The Australian Commission on Safety and Quality in Health Care reports that more than seven million clinical handovers take place in Australian hospitals and over twenty six million handovers take place in the community care centres (Safetyandquality.gov.au, 2018). These two figures that a colossal amount of clinical handovers take place in Australia which places immense challenge to the professionals to ensure safety of the patients under charge. The report further points out that face to face communication between the medical practitioners result in more effective clinical handovers. However, this method of handovers also attracts the risks of loss of clinical information since the entire communication as well as implementation of the treatment is reliant on the memory skills of the medical staffs (respondents of primary analysis of the research).

Figure 1.Graph showing number of deaths due to falls while stay in hospital

(Source: Aihw.gov.au, 2018)

The graph above published by the Australian Institute of Health and Welfare, Government of Australia shows that number of patient deaths due to fall while being admitted in hospital between periods of 2015-2016. The graph shows that the fall rates increase with the age when patients lose their locomotion power. The World Health Organisation in its bulletin reports that the occurrences of patient death due to lack of care from the side of the medical practitioners are often not recorded and reported (Who.int. 2018). Thus, here it can be inferred from the graph published by the Australian Institute of Health and Welfare, Government of Australia and the WHO that the role of improper clinical handovers due to cannot be underestimated. The Australian Commission on Safety and Quality in Health Care in this regard further reports that lack of communication between the medical staff members results in poor handover of clinical responsibilities, delays in treatment, repeated medical tests, incorrect treatments and medication errors, all of which are capable of causing death of patients. Kaye et al. (2015) shed light on the role of clinical handover towards patients’ health risk management. They throw light on the fact that improper clinical handover does not only cause risks to aged patient but also to patients under critical medical conditions like pregnancy. Lack of proper clinical handover and communication gaps between staff members of hospital have culminated in pregnancy trauma as well as other medical complications. Perkins et al. (2016) makes the arguments of the previous stronger by pointed a second risk which improper clinical handovers can attract-legal risks. The patients or their representatives may file cases against the hospitals due to the lack of improper treatment which might have stemmed due to improver clinical handovers. Thus, clinical handovers done in inappropriate methods do not create risks for the patients but the organisations as well. An analysis of these sources of information clearly shows that the appropriate clinical handovers plays very significant role in risk management of patients as well as to the hospitals.

Overview of the Study

Figure 2. Risks due to inappropriate clinical handover

(Source: Perkins et al. 2016)

Importance of communication in clinical handover:

Communication holds tremendous importance in clinical risk management especially in case of clinical handover. This makes it very crucial for medical practitioners to maintain continuous communication while serving patients. Primdahl (2015) sheds light on the seriousness of the role of communication in taking care of cardiovascular patients who need uninterrupted medical attention. Kitas (2015) introduces another category of patients in need of continuous medical attention, the patients suffering from arthritis. Preiser et al.(2015) point out that patients suffering from neurological problems and balance issues need continuous attention as well as assistance of medical attendants. These categories of critical patients (respondents of primary analysis of the research) are in continuous need of support and assistance of nurses. Asfaw, (2015) further points out that continuous attendances of nurses and carers acts as mental support for patients. This mental support motivates them to recover faster, thus promoting to their wellbeing. Thus, it is clear from the discussion that patients, especially critical patients require continuous attention from carers. This necessitates the medical staff maintain smooth communication among themselves while changing shifts. Hailemariam et al.(2016) further mentions that medical practitioners should exchange complete information about the medical requirement of the patients under charge. This is very critical to ensure appropriate medication and speedy recovery of the patient. Thus, it can be inferred that the communication plays significant role in clinical handover to ensure management of risks to health of the patients.

Challenges in the process of clinical handover

According to Redley et al., (2017) sources found from a survey report of summative content evaluation of almost 130 patinets that contexts of clinical handovers were not performed in a holistic way. In addition to the analysis of tape recorded data shows that clinical handovers does not structured content. The content consisted of differ net style of presentation, irregular body and incomplete narration.

Miller et al., (2018) stated that another major sub themes that has been deduces from the study is that nurses often are seen to have low ethical and lack of practical engagement.  In this context, data revived from multiple sources found that in spite of the case method system that is being carried out, the nursing care providers did not have any active role in the process of handover.

Moreover, the data from observations received from various resources and tape records found that clinical handovers were not based on ethics. As stated by Watson et al., (2015) poor management during clinical handover practices were seen to be another major issue. In this context, interviews data and several field observation reported that time and space of handover were not managed in an effective way, there were poor management of time, hasty reports with several interruptions during the process of clinical handover.

Objectives of the research:

The review objectives of the research would be to study the relationship between two variable elements. The first variable is the effectiveness of communication in clinical handover and the second variable would be patient safety. The criteria considered for the research would be secondary sources like articles and works by different authors as well as information available on reliable websites.

Criteria for considering studies for the review:

Types of studies

The studies conducted were concerned with systematic review that examined methods to limit and prevent the clinical errors during the process of clinical handover in different medical care stings. In this, the nursing care providers concerned the studies with the effective use of communication while performing clinical handover.

Types of participants’

The participants of the project are the nursing care providers and registered nurses, endorsed registered nurses with an authority to clinical handovers and communication.

 Types of intervention

All the strategies used by the care providers is to enhance the communication to increase the safety of clinical handover while dealing with patents in acute and healthcare settings. The studies also considered controlled RCT trials and other components of clinical process.

PICO (Problem, Intervention, Control and Outcome):

The paper would deal with the problem of risk to wellbeing of patients due to improper clinical handover. The intervention in this case can be proper recording of clinical handover and data maintenance using electronic method. This would enable hospital managers ensure that the clinical handovers take place efficiently. The hospital in order to control clinical handovers should provide complete patient treatment data to the carers. This would ensure proper treatment of the patient, thus minimising risks to their wellbeing. The outcome of efficient clinical handover would be reduction in patient injury or death due lack of care as a consequence of improper clinical handover.

The tools and methods used in the research was associated with secondary analysis. This secondary analysis would lead to study of immense amount of work done in the field of clinical handover. Moreover, the hospitals and the medical centres while executing clinical handover have to follow the laws and protocols laid down by the Government of Australia as well as the government of the domicile state(s). This makes it pertinent for the thorough study of government websites and articles related to clinical handover (Safetyandquality.gov.au, 2018). The next research method was secondary analysis methods through systematic reviews of AMSTAR.

It can be justified that both secondary analysis are important to conduct research on the topic mentioned. This is because clinical handover is a critical area of medical treatment and already has an immense of literature dedicated to it. Further, the medical practitioners have to follow the protocols laid down by the government of Australia. This makes it important to study the secondary data sources. The research on the relationship between clinical handover and patient health risks would also require primary analysis of RCT studies. Secondary analysis would enable getting deeper insight into the issue of clinical handovers. Thus, it can be justified that both secondary and primary analysis are important to carry on the research.

The data extraction would take place both from secondary as well as from primary data as well from secondary data. This would lend richness to the research. The study has been conducted in a regional hospital setting located in Australia that provides range of inpatient services including emergency services.

The data synthesis would take place by amalgamation of using review system. The presentation would take place in form of a report.

Figure 3. Flowchart showing paper selection process

(Source: Author)

Note: The flowchart diagram does not include gathering information from the government websites.

The quantitative and the qualitative evidence gathered as per the flowchart shown above shows that the entire collection process would consist of study of several articles. Eight studies have been conducted in the systematic review with a before after design followed by three controlled method of clinical trials that have been performed in different healthcare settings that successfully met the criteria of inclusion. The objective of the study was to find out the effectiveness of the team communication during clinical handover specifically while communicating telephonic calls from the nurses to the healthcare professionals. The results in this context show that the studies were heterogeneous with the accordance to the characteristics of the study specifically during patient related results. In total 25 different patient related outcome was measured in the study out which 8 were reported to have shown some significant improvement.

The search of literature were identified amongst 1437 articles from which 482 articles have been removed for their duplicate contents. In this, 955 articles remained after the exclusion of the duplicated and unauthentic articles. In this, full articles were retrieved for further examination, from which 922 were excluded after evaluating their titles and abstracts. From the remaining 19 articles, all of the articles were completely evaluated in their full text amongst all these 16 articles were finally included in the review. The AMSTAR score was seen to be nine. However, several AMSTAR items were not properly reported in the review such as exposure of conflicts of interest amongst individual. Moreover, other AMSTAR components were hardly reported. It has been seen that the AMSTAR rate on the inclusion was ICC 0.85(90% CI 0.85 to 0.90). However, no additional studies were identified during screening of the references given in the articles.

The ratter agreement on the studies quality was good. In this context, the randomised controlled trial by Miller et al. (2018) have been rated as the most strong one and the trial by Ding et al. (2016) has been considered as the moderate one in the above study quality while the remaining 8 studies were considered to be the weak ones.

These studies were rated as strong in terms of the design and category, specifically because these studies were controlled clinical trials. In this, the eighth studies have been used before the study framework resulted in a weak rating in the study design category. Except for the study conducted by Sassoli & Day (2017), the study did not describe adequate details the quality of study regarding the selection criteria was seen as moderate. The study by Anderson et al. (2015), used a design of RCT as a design with and faculty of randomisation unit. Therefore, for the design of study, the results were controlled for the potential such as infrastructure, safety of patients, culture and management. However, the main outcome, study object8ves and application of ISOBAR intervention was described in the study that was not describe in any of the studies leading to a moderate rating in the classification of controlled trials. In this context, the reviews that rated that clinical handover outcome were biased in regards of the interventions,

Overall, there was a lack of reporting on the statistical data and number of professional trainers Moreover, there were problems in the calculations of sample size in ensuring the sufficient power have not been reported in any of the studies.

The integration of information from the industrious analysis of the articles and primary analysis brings forward certain contradictions. The findings do point out that appropriate communication plays important role in clinical handover. It has also come to the forefront that effective clinical handover plays crucial role in ensuring wellbeing of the patients. The findings also show that the clinical handover in hospitals is governed by laws and protocol which medical practitioners have to follow in Australia. However, the rising number of falls of patients, especially aged patients in hospitals actually contradicts the actual implication of laws in the area (figure 1).

The analysis conducted above has encountered several limitations throughout its stage of commencement. The first limitation it faced was limitation of time as the scope of the project was large and requires a longer tenure. However, it had to be completed within a predetermined time. The second limitation was availability of reliable secondary data. As shown in the flowchart above, a large number of articled had to be analysed in order to gather a body of data which is authentic and could be used for the research (figure 1). The third limitation which the research faced was gaining access to RCT data was not easy. The fourth limitation was that it was not always possible to interview patients for long time so as not to put them under stress.

Conclusion:

The above discussion clearly shows that clinical handover based on strong communication between staff involved is of strong importance as far as patient safety is concerned. The hospitals in Australia should ensure that there is effective handover of clinical responsibility and accountability. Clinical handover is not only a functional area of hospital operations, it has strong ethical aspects as well. The medical staff should be responsible and ethical while transferring clinical responsibility. The research can form support for future research about medical ethics and accountability of medical professionals.

The implications of effective clinical handover would result in faster patient recovery and lower number of accidents as well as death to the improper clinical handovers. The research under consideration can encourage future research in fields of nursing and paramedical profession.

The practice implies that inefficient clinical handovers are still prevalent in hospitals in Australia. It can also be implied that the intense pressure to treat the ever increasing number of patients put immense pressure on the medical staff. This implies Australian medical industry should acquire more medical staff to ensure more efficient patient care.

It can be implied from the research that the doctors and nurses should more responsible while taking clinical handovers. They should to ensure safety and security of patients.

References:

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