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.
Rolling in the new year with the first national research event
Every year about this time I say this: can you believe that another year has gone? But can you though?
It has been a busy year in relation to research activities for paramedics, with an increasing number of paramedics registering for doctoral level studies and masters programmes across the UK. Plus there have been growing numbers of applications for grant funding being submitted with paramedics on the grant application teams, and a significant number of research-based papers have been written by paramedics and published in a wide range of peer-reviewed journals. These are all strong markers of continued development of an evidence-based professional culture—clearly there is still a way to go but we should applaud the progress being made!
So what about the year to come?
I am taking this opportunity to unashamedly promote the first national research event being run by the College of Paramedics on 28 May 2015: ‘Pre-hospital research: questions at the cutting edge of emergency care’.
This research event offers a platform for discussion of contemporary issues related to the development, funding and undertaking of research relevant to the paramedic profession. It will be of interest to those who are already engaged in, or who want to be involved with, research, and who also want to make contact with other like-minded individuals from around the UK.
This will be an excellent networking opportunity and a chance—among other activities—to hear about completed research that paramedics have been doing over the past couple of years.
How many times have you heard people say: ‘I wish I had been given the opportunity to present about my work?’ or ‘Why didn't they ask me to speak?’—well now is your chance. Get an abstract submitted!
This is an open competition and the people with the top 6 highest scoring abstracts will be invited to give oral presentations at the research event (with the best presentation being awarded an international travel prize to speak at an overseas conference).
Other applicants may be offered a poster presentation, which is another effective way to get the key messages from your research across to a professional audience.
If you have completed a research study and you want to present at the event you can get the abstract submission form, with guidelines, from the College of Paramedics' website: www.collegeofparamedics.co.uk/events/pre-hospital-research-conference-2015. Forms must be received by 17:00 on Friday 3 April 2015.
In addition to these presentations there will be other sessions delivered examining issues such as research ethics, following a research career, and current challenges to ‘pre-hospital research’.
Additional activities include a ‘shop window’ event where you can post up brief messages about research that you want to get off the ground and perhaps you are looking for other people who would be interested in helping you; or you might want to test out some ideas with other research interested paramedics.
There will be a support group for postgraduate research students; and a workshop on getting started in research. It is going to be a lively event so do not miss out as places are limited. Bookings are open on the College of Paramedics' website: www.collegeofparamedics.co.uk/events/pre-hospital-research-conference-2015.
So if your New Year's resolution is to make some changes within your professional life, come and check out research at this event—there may be more options than you think!
So on behalf of ‘Spotlight on Research’ may I wish you a very Merry Christmas and a Happy New Year! P.S. See you on 18 March…