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The Silent Killer: Clinical Handover

More than two decades ago it was estimated more than 18,000 deaths occurred annually in Australia as a result of medical errors. A significant portion of these deaths are preventable and have their origins in communication failures in a health system plagued by the use of dated communication solutions and siloed software solutions that don’t talk with one another 1,2.

Communication breakdown as a major cause of preventable patient harm continues to go under-recognised and under-reported. In Australia, 11% of preventable deaths are considered due to communication issues3. In the United States, between 1995 and 2006 communication breakdowns were identified as the single leading root cause of adverse patient events4.

Clinical handover as a key component of clinical communication:

Clinical handover – defined as the transfer of accountability and professional responsibility for some or all aspects of patient care from one person or professional group to another is a critical aspect of patient care. The handover process invariably involves the transfer of sensitive patient information between individuals or groups, sometimes in a time-critical fashion.

Effective handover is essential to safe patient care. Poor handover can lead to delays in diagnosis, treatment delays, incorrect treatment, life-threatening adverse events and has broad medicolegal implications for health organisations and individual practitioners.

Some key methods used to maximise safe and effective clinical handover include5,6:

  1. Have specified times and locations for handover.
  2. Have structured and standardised handover documentation.
  3. Use a combination of verbal and written communication.
  4. Provision of handover training for doctors.
  5. Setting clear and consistent expectations for handover.

Trends in inpatient clinical handover in Australian healthcare

On any given weekday in Australian public hospitals up to 30,000 clinical handovers occur7.

Historically clinical handover in this setting has been poorly executed. For instance, last decade local research commissioned by the Australian Medical Association found that only about 5% of doctors reported using structured and/or formal approaches to clinical handover4.

In recent years, the introduction of fatigue management practices and safe working hours has seen a reduction in junior doctor working hours. Whilst this is clearly a positive step, the by-product of better hospital staffing is that more doctors are inevitably involved in a patient’s care and therefore, continuity of care is more fragmented. A numerically greater number of clinical handovers occur for any given patient as more doctors are involved in patient care. With this comes the potential for more miscommunication and medical errors, particularly if safe and effective handover systems are not utilised.

Health practitioners and managers increasingly recognise the importance of structured clinical handover practices and is now on the national health agenda. In 2013 The Australian National Safety and Quality Health Service (NSQHS) Standards took effect. These ten published standards focus on areas considered essential to safe and quality healthcare. Standard 6 addresses clinical communication and clinical handover.

Despite the introduction of these standards, recent research conducted in a single Australian public hospital indicated more than half of junior doctors thought that current handover practices remained inefficient. More than 69% reported challenges in keeping track of the information they were handed over which was usually paper-based. Electronic handover methods including the use of a structured template were considered advantageous6.

Clinical handover in the outpatient setting

Clinical handover from hospitals to GPs is done inconsistently and poorly. Few patients leave hospital with an effective clinical handover7. Discharge information is often provided as unfiltered, raw data on discharge summaries but is rarely provided in a succinct, real-time fashion at the time of patient discharge, greatly reducing its relevance.

Enter Foxo

A one approach fits all approach is clearly not possible in something as complex as patient care and clinical handover. The type and approach of handover must be tailored to the clinical situation. Organisations must develop structured handover processes and provide appropriate leadership and ongoing training to clinicians. The use of verbal communication, ideally face-to-face, will always remain the gold standard but this should be supplemented with written documentation where possible. Digital solutions including mobile messaging solutions such as Foxo enhance the clinical handover process by providing encrypted communication across organisational boundaries. Real-time patient-centric messaging and activity logs identifying every clinician involved in the patient journey provide efficient, transparent, and accountable communication. To learn more about Foxo, including the dedicated clinical handover feature visit here. Alternatively, if you are ready to get started, set up your free account here at www.foxo.com.


Suggested reading:

  1. Australian Medical Association. Safe Handover: Safe Patients. Guidance on clinical handover for clinicians and managers, 2006.
  2. National Safety and Quality Health Service Standards 2nd Edition

References:

  1. Wilson, RM et al The Quality in Australian Healthcare study Med J Aust 1995 Nov (6) 163 (9): 458-471
  2. https://www.abc.net.au/worldtoday/content/2013/s3778256.htm
  3. Zinn C. 14,000 preventable deaths in Australia. BMJ, 1995, 310:1487.
  4. Root causes of sentinel events, all categories. Oakbrook, IL: Joint Commission, 2006 (http://www.jointcommission.org/NR/rdonlyres/FA465646-5F5F-4543-AC8F-E8AF6571E372/0/root_cause_se.jpg, accessed 12 June 2006).
  5. Standard 6 Clinical Handover Safety and Quality Improvement Guide October 2012 Australian Commission on Safety and Quality in Healthcare.
  6. Pascoe, H, et al Clinical handover: An audit from Australia Australas Med J. 2014; 7(9): 363-371
  7. Australian Institute of Health and Welfare. Australia’s Health 2006. Canberra, 2006.’
  8. Bomba D & Prakash R. A description of handover processes in an Australian public hospital. Australian Health Review. February 2005; 29: 68-79.
  9. Mclean Katrina et al GPs want clinical handovers, not discharge summaries. Insight March 2018.

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