Improving Handover in Healthcare is Vitally Important to Productivity and Patient Safety
Effective handover in healthcare, which includes not just end-of-shift handover but also referrals between teams and changes of care setting, is essential for maintaining continuity and ensuring patient safety during transitions. Inadequate handovers can lead to errors, miscommunication, and compromised patient outcomes.
Personally, I know this: my mother nearly died because someone forgot a vital piece of information at handover, leading to dangerous fluid overload.
My colleagues and I recently undertook a global study, and the results confirm that handover remains unsafe and badly organised everywhere. ("Safety of Handover: A Global Online Survey of Clinical Practitioners and Leaders Regarding Patient Safety during Transitions of Care" available here).
We found that 12 - 14% of our respondents reported errors occurring more frequently than once a week. A third had witnessed moderate or severe harm from handover errors. Nearly one-fifth of respondents said that handover was high a high-risk activity.
More worryingly, almost all respondents used a combination of handover systems. Over 20% relied on standard office systems such as word processors or spreadsheets for peer-to-peer handover; over 30% used hand-written or manual systems.
As medicine and healthcare become more complex and patient journeys longer, there is an urgent need for improvement in the way that handover is delivered within and between institutions. By addressing the shortcomings in handover practices, healthcare organizations can improve both productivity and patient safety.
The Scale of the problem
We uncovered significant challenges within handover practices across healthcare settings. One of the major concerns highlighted was the lack of standardization, auditability, and the sheer plethora of handover systems, many of which were manual. This leads to variations in care, communication methods and documentation formats. These discrepancies pose risks in information transfer and increase the likelihood of errors during handovers. Furthermore, inadequate training on handover processes and time pressures were identified as key safety concerns.
The implications of these problems extend beyond patient safety alone; they also impact productivity within healthcare organizations. Incomplete or inaccurate handover information can cause delays in care, poor decision-making, duplication of tests, and adverse patient outcomes. Miscommunication and information gaps can lead to simple misunderstandings but also to errors in medication administration and, as in my mother’s case, significant harm. Inefficient handovers consume valuable time and resources, affecting the overall efficiency and productivity of healthcare delivery.
Everyone who has worked in healthcare knows this.
The Need for Urgent Change
Given the scale and impact of the problems identified in the study, it is evident that urgent changes are necessary to improve handover practices, which – as I stated early – include transitions of care between teams and institutions. Standardization plays a pivotal role. Implementing standardized processes, documentation formats, and communication protocols can enhance the reliability and accuracy of information transfer, reducing the risk of errors and misunderstandings.
It's also vital that institutions invest in training and education on handover processes to ensure healthcare professionals have the necessary skills and knowledge. This includes effective communication strategies, prioritization of critical information, and techniques to manage interruptions and time pressures. By providing thorough training, healthcare organizations can equip their staff with the tools to conduct safe and efficient handovers.
Finally, the adoption of technology can greatly enhance handover practices. Electronic handover tools, such as the CAREFUL platform (www.careful.online) developed by my team and I, offer a structured and streamlined approach to handovers. These tools provide standardized templates, real-time updates, and secure information sharing, ensuring the seamless transfer of vital patient information. Integrating such technology into handover processes can significantly improve accuracy, efficiency, and patient safety.
With such dedicated collaboration platforms, healthcare professionals can rely on improved visibility and accountability of tasks, as well as consistent and accurate information transfer. Such systems can be real-time, enhancing and complimenting the standard – and usually clunky – EMR systems that are prevalent in healthcare.
Installing systems that cross the boundaries that exist within and between organizations is essential.
Given the harm that poor communication does, improving systems of handover is of vital importance not just to productivity but patients everywhere.
