National Clinical Handover Initiative Pilot Program resources

This project assessed the role of a standardised format ‘ISBAR’ - ‘Introduction, Situation, Background, Assessment and Recommendation’ – across one sending and two receiving hospitals for inter-hospital transfers.

The assessment included surveys and interviews with clinicians, patients, carers and staff from the Patient Flow Unit and those involved in transporting patients. Many participants reported that the best elements of the ISBAR framework were that it was simple, memorable and portable. Staff had increased confidence in giving and receiving clinical handover and audits of medical charts indicated that the quality of information improved.

A comparative incident analysis between the sending facility and a similar hospital suggested a heightened awareness surrounding clinical handover. Overall, ISBAR was well-received and continues to be used and spread across the region.

Produced by Hunter New England Area Health Service:

• ISBAR Poster
• ISBAR Notepad
• ISBAR Prompt card template
• ISBAR Project Toolkit
• ISBAR revisited: case study 1 video
  
• ISBAR revisited: case study 2 video
  
• ISBAR revisited: case study 3 video
  

In this study, GPpartners improved the flow of information in residential aged care facilities and hospitals transfers and developed an audit tool to measure changes.

GPpartners study aims

This study focused on:

• How admission and discharge information is currently received
• Types of information received
• The possible impact on clinical outcomes.

GPpartners study methods and results

Two audits were performed three months apart, on both admissions and discharges of residents in RACFs. Two methods for improving patient information flow in these transfers were promoted between the first and second audits These were:

• The Yellow Envelope (paper-based)
• Health Records eXchange (electronic).

Results show improvement on some indicators in the second audit. These included:

• An increase of clinical information included in admissions
• An increase in discharges received with the resident.

Produced by GPpartners:

• Admission audit tool
• Discharge audit tool
• Guidelines for audit tools
• Clinical audit toolkit

This project reviewed the structures, processes and outcomes of bedside nursing handover and whiteboard assisted communication as two strategies to improve the type and accuracy of information communicated among health professionals.

Communication of patient information

Researchers from Griffith University Research Centre for Clinical Practice Innovation, Queensland Health Patient Safety Centre and Peel Health Campus, Western Australia worked on this project.

Good communication of patient information, both within and between professional groups, is key to ensuring patient safety and continuity of care.

Efficient Bedside handovers were seen to improve accuracy and promote patient-centred care.

When successfully implemented, whiteboards were perceived to be useful prompts for referral and timely discharge, however unsuccessfully implemented, it was seen as an imposition of management and a cause of conflict between members of the multidisciplinary team.

Produced by Griffith University:

• Bedside handover SOP
• Whiteboard communication SOP

Transfer of residents from aged care homes to hospital is a high-risk clinical handover scenario. This study was a one-year trial evaluating a range of aspects of using the aged care facilities Transfer-to-Hospital Envelope.

Study details

The North East Valley Division of General Practice, Victoria carried out this trial of the Envelope. Evaluation methods included written surveys and semi-structured face-to-face interviews.

The Envelope contains documents, and the back features a checklist of crucial clinical and other handover information to be included when a resident is transferred.

Consistent positive findings indicate that the Envelope has the potential for much wider use.

Produced by North East Valley Division of General Practice:

• Aged Care Transfer-to-Hospital Envelope with Template
• Procedures for Transfer-to-Hospital Envelope
• Minimum Information Set Transfer Form

HELiCS stands for Handover: Enabling Learning in Communication (for) Safety. It is a clinical tool for ongoing observation, improvement and evaluation of clinical handover. 

The HELiCS kit was devised by the University of Technology Sydney, Centre for Health Communication. It is an approach to staff learning that centres on involving frontline clinicians in reflecting on practice, using actual video footage of their handovers.

The kit includes a:

• 20-minute training DVD with examples of actual footage from the participating clinical sites, and visual examples of how handover practice improvements occurred in these sites
• Resource booklet that explains the video-based improvement procedure and details the achievements at three case study sites;
• HELiCS website with further visual and published resources, information about the reflexive redesign method, and an interactive forum where clinicians interested in sharing their experiences using video can go to discuss progress, solutions and problems.

Produced by University of Technology Sydney:

• HELICS as a tool for ongoing observation, improvement and evaluation of clinical handover
  
• HELiCS Booklet
• Case Study 1: Emergency Department
• Case Study 2: Intensive Care Unit
• Case Study 3: Spinal Rehabilitation Unit
• Ethical governance

The Nursing and Medical Handover in General Surgery, Emergency Medicine and General Medicine at the Royal Hobart Hospital Project set out to improve operating protocols for clinical handover.

Handover project approach

The project was run by Tasmania Department of Health and Human Services, Royal Hobart Hospital and University of Tasmania.

This project  developed transferable standardised operating protocols incorporating minimum data sets for medical and nursing shift-to-shift handover in General Medicine, General Surgery and Emergency Medicine at the Royal Hobart Hospital.

The project utilised a holistic socio-technical approach to understand and improve clinical handover. This approach integrated clinical and information systems expertise with qualitative field techniques, as well as user-centred education and training. The model of an iterative feedback loop to support continuous improvement was used to gather information and then continually revise practice.

Project deliverables

The project’s outputs were structured into four major deliverables:

• Stakeholder engagement protocol
• Minimum data sets for clinical handover
• Standardised Operating Protocols (SOPs)
• Training materials for implementation of SOPs.

Produced by Royal Hobart Hospital:

• Stakeholder Engagement Protocol
• Minimum Data Set
• Standard Operating Protocol
• Training Materials (Nursing - General Medicine)

This project identified the risk factors involved in acute patient transfers in the Western Australia health system, and trialled strategies that would assist in addressing the risk factors identified. It generated a number of iSoBAR resources.

Western Australia Country Health Service undertook this project in partnership with Royal Perth Hospital (RPH). It reviewed the complex processes involved in both referral and the arranging of patient transport in the WA health system.

iSoBAR project outcomes

A minimum dataset form was created, specifically for care of the deteriorating adult medical patient, involuntary mental health patients and obstetric emergency patients. RPH also developed an educational toolkit based on the mnemonic iSoBAR to aid training on standardising inter-hospital transfers.

Produced by Western Australia Country Health Service:

• Inter-Hospital Patient Transfer Form
• iSoBAR Promotional Materials
• iSoBAR e-learning educational toolkit
• Help file on how to install and run the electronic toolkit

SHAREing Obstetric Care – Clinical handover between VMOs and Midwives was a pilot study carried out by Mater Health Services Brisbane Limited.

It sought to address the communication issues associated with the critical time around:

• referral from the midwife to the VMO when a change in the woman’s condition is diagnosed
• referral from the VMO to the recovery nurse/midwife post-Caesarean section.

The project included pre- and post-implementation measures using clinician surveys, chart audits, clinical incident data and patient satisfaction data.

This project found that using SHARED to define the minimum dataset can improve the accuracy and appropriateness of information exchanged for clinical handover.

Produced by Mater Health Services Brisbane:

• SHARED Graphic
• SHARED Poster
• SHARED Swing Tag
• SHARED Sticker
• SHARED Resource Guide
• SHARED phone handover for communicating a critical situation, or change in patient condition
• SHARED Carepath Inserts Post C-Section Recovery Room Handover
• SHARED Carepath Inserts Post Operative Recovery Room Handover
• SHARED Carepath Inserts Well Term Newborn

St John of God Health Care – NSW Services developed and implemented this study. Using the quality improvement Plan, Do, Study, Act model, the stakeholder collaborative developed:

• clinical handover documentation
• processes
• comparative clinical indicators
• revised hospital policy.

These support the uptake of evidence-based practice for clinical handover, hospital to community provider for mental health patients.

Preliminary clinical audit results suggest that adherence and compliance with the revised process is being achieved.

Observed changes imply that the new communication strategy is effective in the promotion of an environment where:

• the risk of adverse events for patients should decrease
• organisational management should improve.

Produced by St John of God Health Services:

• Hospital Discharge Summary Booklet
• Roles and responsibilities in completing the clinical handover (discharge) process
• Algorithm for Planned Patient Discharge Process
• Community Practitioner Referral Form

Albury-Wodonga Private Hospital – Ramsay Healthcare initiated this program. It used the PACT mnemonic – Patient Assessment, Assertive Communication, Continuum of Care for Patient Safety, and Team Work with Trust.

Baselines surveys with both doctors and nurses identified key issues in clinical handover, and SBAR principles informed the development of two communication tools:

• A handover prompt card provides a template for standardising shift-to-shift and person-to-person handover. It guides the speaker in a sequence thereby establishing a routine that also enables the receiver to note if information is omitted.
• A reporting template provides a standard template for nurses contacting visiting medical officers (VMOs) to report deterioration in a patient’s condition.

The format assists nurses to structure their communication in a logical sequence, facilitating rapid comprehension from VMOs. The clinicians felt that these handover tools improved their confidence level significantly when communicating.

Produced by Albury-Wodonga Private Hospital:

• SBAR communication tool
• Using the SBAR tool
• Handover prompt card
• PACT poster

The project was carried out by Deakin University in collaboration with Epworth, Cabrini and Alfred Hospitals.

The focus of this quality improvement project was an in-depth evaluation of inter-professional communication and team work during clinical handover in Post Anaesthetic Care Units (PACU).

Handover improvement outcomes

This project led to the development of valid and practical tools and measures of safety and quality in clinical handover specific to the PACU in the private sector. These tools appear to be transferable across the public health care sector.

Handover improvement solutions included:

• process improvement tools
• standardised structure and content tools (ISOBAR and minimum data checklist)
• tools for ongoing quality monitoring and evaluation to ensure clinical handover practices are both robust and resilient in the workplace.

Produced by Deakin University in collaboration with Cabrini, The Alfred and Epworth Hospitals:

• Handover ID card
• A3 Booklet on Using tools to evaluate the quality of inter-professional clinical handover

The project was carried out by South Australian Department of Health, University of South Australia and University of Tasmania. The research was oriented around the implementation of an electronic tool to support different forms of clinical handover in each of the hospitals.

Research at three South Australian hospitals provided the basis for the development of A Guide for the Safe use of electronic handover tools (PDF 1828 KB). The guide is designed to assist all stages of the design and use of electronic handover systems.

SafeTECH project findings

It provides guidance to clinicians, medical administrators, quality and safety staff and health informatics professionals.

Overall, the project found that change management was particularly critical when implementing electronic systems to assist clinical handover.

It is critical that the approach to implementation emphasises that the electronic tool should support, and not replace, processes for handover.

Produced by South Australia Department of Health and University of Tasmania:

• Safe use of electronic handover tools