Clinical handover of patients between nurses in the emergency department and somatic wards – an explorative interview study.

Abstract

Background: Leading international health organizations have focused on improving the quality of clinical handovers. Research demonstrates areas for improvement where clinical handovers in healthcare are essential for quality, safety, and continuity of patient care. One hospital had received many incident reports about the quality of interdepartmental handovers between the Emergency Department and somatic wards, and wanted to improve them. Aim: The aim of this study was to explore how clinical handovers are experienced between the ED and ward nurses, and gather suggestions for improvement.

Method: This study pursued a qualitative, inductive, explorative approach with 6 focus group interviews of nurses (N=19) on both ends of the ED-Ward handover (2 ED, 1 surgical, 3 medical). The interdepartmental handover is by telephone from ED to ward nurses. Graneheim and Lundman’s (2004) content analysis method was used to analyze interview texts. Rasmussen’s system approach and Dynamic Safety Model formed the theoretical basis for interpretation. Results: Four bodies of data emerged from the interviews: Poor handovers and Successful handovers from ED or Wards’ perspectives. Poor handovers occurred in a busy ED without handover structure where efficiency trumps quality causing consequences for nurses and patients on the wards. Nursing assessments and documentation lacked, and patients’ status upon arrival on wards didn’t always match the handover description. Successful handovers were described as bridging needs of patients and nurses. Conclusion: The results provide evidence for improving the interdepartmental handover but will take organizational buy-in and collaboration over time to develop and implement evidence-based, locally suitable handover routines and protocols.