Spotlight on Research

Julia Williams
Friday, January 2, 2015

Clinical handover: where are we now?Over the years the quality of clinical handover has been identified as an important determinant in patient care when aiming for a smooth transition for the patient from one area of health care provision to another. This paper outlines the findings of a literature search that was undertaken to answer the question: ‘what does published research tell us about handover in pre-hospital settings?’At first glance you would be forgiven for wondering whether this will only include handovers literally in ‘pre-hospital settings’ rather than at the point of handover from ambulance staff to hospital staff. However, the authors explicitly define their interpretation of the term ‘pre-hospital’ and this clearly includes both work outside the hospital as well as at the point of handover between ambulance staff and hospital-based staff.The literature search included papers published between January 2000 and March 2014. Clear inclusion and exclusion criteria are stated within the paper and using these criteria a total of 401 papers were identified.During the subsequent process of screening, 350 papers were excluded as they did not focus on pre-hospital written or verbal handover; and a further 30 papers were excluded as they were either secondary research, conference abstracts or editorials. The remaining papers were assessed for quality using tools based on the work of Greenhalgh (2010) and influenced by the critical appraisal skills programme (CASP).In total 21 papers were included within the review and in Figure 1 (which provides a useful flow-diagram of the review process), the authors identify that 3 were mixed methods, 11 were quantitative and 7 were qualitative studies. Although this is an interesting paper which is for the most part clearly written, there is some confusion in their results section about the total number of papers included in this review as they make reference to 11 quantitative, 8 qualitative and 4 mixed methods studies. This would total 23 studies, which does not tally with the information presented in Figure 1. Having checked the online supplementary information, I can confirm that the total number of studies was, indeed, 21. Don't forget that published papers frequently come with additional information that is supplementary to the main paper which is usually available online—this was useful additional information on this occasion.Final analysis of all 21 papers used a thematic approach which initially produced 32 subthemes which were ultimately reconstructed into four main themes: communication, context, interprofessional relationships, standardisation of handovers.The paper presents insightful discussion around all of these themes using specific examples from the included research studies. Perhaps unsurprisingly there are several studies that identify frustration expressed by paramedics if they experience a lack of ‘active listening’ by their hospital colleagues during clinical handover.Interestingly the authors report that use of mnemonics (such as ASHICE—age, sex, history, injury/illness, condition, expected time of arrival; or MIST—mechanism, injury, signs, treatment) to standardise handover improved structure and consistency in approach and content; however, the literature lacks consensus as to whether this approach improves retention of information by emergency department staff.In conclusion, the authors make recommendations for future research to include focus on organisational and social factors as well as undertaking research on clinical handover once electronic patient report forms are implemented, as this may well impact further on the dynamics of this important element of patient care.This is a valuable paper which summarises relevant literature on ‘pre-hospital’ clinical handover, highlighting that there is still a need to develop in this area of patient care in order to improve patient safety and enhance patient experience.Spotlight on Research is edited by Julia Williams, principal lecturer, paramedic science, University of Hertfordshire, Hatfield, Hertfordshire, UK. To find out how you can contribute to future issues, please email her at j.williams@herts.ac.uk

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