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This paper investigates the dynamics of referring expressions in hospital nurse handover meetings when discussing patients. We apply the methods of the Variable Length Markov Chain (VLMC) and network analyses to model the use of referring expressions and evaluate relationships between them. The models reveal second-order dependencies emerging for metonymy and noun phrases. Specifically, metonymy shows a greater association with the beginning of a reference, particularly in the context of other metonymies. In contrast, noun phrases tend to be more strongly associated with later points in the reference. Further, we introduce the notion of referential typicality, which measures the conformity of sequences of referring expressions to anticipated patterns. We show, for example, that consecutive noun phrases fall outside the typical pattern, whereas metonymical sequences and sequences of pronouns are highly typical. The transitions from metonymy or nouns to pronouns also closely align with a highly typical pattern. Using a Generalized Additive Model (GAM), we then track the overall evolution of referential typicality throughout the duration of handover meetings, from their beginning to end. The study reveals a subtle increase in referential typicality towards the end of these sessions, indicating a trend towards more consistent referencing as the discourse unfolds. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Methods Results Conclusions Impact Patient or Public Contribution To map studies that tested an intervention orienting patient transfer to Postanesthesia Care Unit (PACU) and identify outcomes related to care safety.Scoping review guided by recommendations of the JBI Manual and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for Scoping Reviews (PRISMA‐ScR) guide. The Population, Concept, and Context (PCC) framework was used to develop the research question and consolidate inclusion and exclusion criteria in databases consulted without date parameters. The review protocol was registered in the Open Science Framework.The systematic search identified 182 records. After reading their titles and abstracts, 49 studies were read in full. The final sample consisted of 17 texts published between 2013 and 2024. The main elements evaluated in the implementation of interventions to guide patient transfer to the PACU related to patient safety were as follows: increase in the number of transferred information; higher rates of professional satisfaction with teamwork; presence of surgical professionals; questions from the receiver and adequacy to the instrument. Also was identified a pause to monitor the patient before the transfer and reduction of omitting information, interruptions, distractions, task errors, hypoxemia, nausea, vomiting and excessive pain.The variables evaluated after the interventions to promote a structured patient transfer to the PACU have the potential to guide the development of quality assessment indicators and contribute to the promotion of a safety culture in institutions.Considering the constant increase in complexity and demand for perioperative care, the investigation of patient transfer processes to the PACU can provide support for the management of surgical practices and contribute to improving patient safety and the experience of the health professionals involved.No patient or public contribution.OSF registration: https://doi.org/10.17605/OSF.IO/M2FYN. [ABSTRACT FROM AUTHOR]

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018–2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks – adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019–2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge. [ABSTRACT FROM AUTHOR]

Standardized transfer is an evidence-based framework designed to improve communication between healthcare professionals, reducing risks and ensuring safe, high-quality care. Despite its benefits, implementing this framework in clinical practice poses challenges. Nurses often do not use a systematic guide as a theoretical framework for handovers in daily practice. Objective: To explore nurses' perceptions regarding the use of standardized transfers. Methodology: This exploratory qualitative cross-sectional study aimed to gain insight into nurses' experiences and perspectives on pediatric patient transfers. Using purposive sampling, nurses from the pediatric intensive care unit and hospital wards at the hospital institution hosting the study were interviewed. Data were collected through 21 in-depth individual interviews conducted between April and May 2023. The semi-structured interviews, lasting 16 to 28 min, focused on nurses' views on communication between units during patient transfers. The qualitative approach allowed for a comprehensive understanding of nurses' perceptions, particularly the barriers they face in practice. The study included 21 nurses: 9 from the pediatric intensive care unit and 12 from pediatric wards. To ensure diverse representation, nurses with varying levels of work experience were included, and at least one nurse from each hospital ward participated. Results: The data were classified into the following main categories: the current state of pediatric patient transfers, attitudes of healthcare professionals, barriers and challenges to implementation, nursing documentation, motivational aspects, and the child-family relationship. The findings revealed significant issues in the communication process during patient transfers, with no systematic guidelines in place. While nurses demonstrated a positive attitude toward the standardization of transfers, they identified numerous practical challenges, particularly those related to the hospital's nursing documentation system. Conclusions: Nurses view standardized transfers favorably, but they face substantial barriers that limit their practical implementation. [ABSTRACT FROM AUTHOR]

Paulo Cruchinho,1 María Dolores López-Franco,2 Gisela Teixeira,1 Pedro Lucas,1 Filomena Gaspar1 On behalf of the Handovers4SafeCare1Nursing Research, Innovation and Development Center (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, Portugal; 2CTS-464 Nursing and Innovation in Healthcare, University of Jaén, Jaén, SpainCorrespondence: Paulo Cruchinho, Nursing School of Lisbon, Avenida Prof. Egas Moniz, Lisboa, 1600-190, Portugal, Tel +351 217913400, Email pjcruchinho@esel.ptPurpose: The Bedside Handover Attitudes and Behaviors questionnaire is a 32-item instrument originally developed in English that enables nurse managers to monitor the consistency of nurses’ practice during the implementation of the Nursing Bedside Handover. We aimed to cross-culturally validate this questionnaire for the Portuguese population and to examine its psychometric properties.Methods: An exploratory-descriptive, quantitative, cross-sectional, and validation study was conducted. A sample of 241 nurses from a Portuguese acute care hospital participated in the field test. The questionnaire was cross-culturally adapted through translation, translation synthesis, and back-translation procedures, an expert committee harmonization, and two pre-tests.Results: We obtained one factorial solution through exploratory factor analysis that explained 53.5% of the total variance, with 18 items distributed by four components: Direct Engagement, Personal Interaction, Information Sharing, and Individualized Approach. Confirmatory factor analysis supported the four-factor factorial structure of the questionnaire X2/df = 1.440; CFI = 0.0953; GFI = 0.926; RMSEA = 0.043; P[rmsea] < 0.001; MECVI = 1.175). Cronbach’s α indicated acceptable reliability for the total questionnaire (α = 0.790). The refinement of the instrument led to the proposal of a new Conceptual Model for Patient Participation in Nursing Bedside Handover.Conclusion: The questionnaire is valid and reliable for use by Portuguese nurse managers. This adapted version of the BHAB questionnaire can be applied by nurse managers to facilitate the implementation of Nursing Bedside Handover.Keywords: patient handoff, patient participation, patient-centered care, patient safety, validation studies, nursing administration research

OBJECTIVE: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

Standardized transfer is an evidence-based framework designed to improve communication between healthcare professionals, reducing risks and ensuring safe, high-quality care. Despite its benefits, implementing this framework in clinical practice poses challenges. Nurses often do not use a systematic guide as a theoretical framework for handovers in daily practice. Objective: To explore nurses’ perceptions regarding the use of standardized transfers. Methodology: This exploratory qualitative cross-sectional study aimed to gain insight into nurses’ experiences and perspectives on pediatric patient transfers. Using purposive sampling, nurses from the pediatric intensive care unit and hospital wards at the hospital institution hosting the study were interviewed. Data were collected through 21 in-depth individual interviews conducted between April and May 2023. The semi-structured interviews, lasting 16 to 28 min, focused on nurses’ views on communication between units during patient transfers. The qualitative approach allowed for a comprehensive understanding of nurses’ perceptions, particularly the barriers they face in practice. The study included 21 nurses: 9 from the pediatric intensive care unit and 12 from pediatric wards. To ensure diverse representation, nurses with varying levels of work experience were included, and at least one nurse from each hospital ward participated. Results: The data were classified into the following main categories: the current state of pediatric patient transfers, attitudes of healthcare professionals, barriers and challenges to implementation, nursing documentation, motivational aspects, and the child-family relationship. The findings revealed significant issues in the communication process during patient transfers, with no systematic guidelines in place. While nurses demonstrated a positive attitude toward the standardization of transfers, they identified numerous practical challenges, particularly those related to the hospital’s nursing documentation system. Conclusions: Nurses view standardized transfers favorably, but they face substantial barriers that limit their practical implementation.

Diagnostic errors in emergency departments (ED) are a significant concern and exacerbated by cognitive biases during patient handoffs. The timing and accuracy of disclosing working diagnoses during these handoffs potentially influence diagnostic decisions, yet empirical evidence remains limited.This parallel, quasi-experimental study involved 40 interns from Japanese teaching hospitals, randomly assigned to control or intervention groups. Each group reviewed eight audio-recorded patient handoff scenarios where working diagnoses were disclosed at the start (control) or end (intervention). Four cases presented correct diagnoses, while four featured incorrect ones. The main measure was diagnostic error rate, calculated as the proportion of incorrect post-handoff responses to total questions asked.No significant difference in diagnostic error rates emerged between the control (39.4 %, 63/160) and intervention (38.8 %, 62/160) groups (point estimate −0.6 %; 95 % CI: −11.3–10.1 %, p=0.91). However, a substantial difference was evident between diagnostic errors after correct (20.6 %, 33/160) and incorrect (57.5 %, 92/160) working diagnoses presented (point estimate: 36.9 %; 95 % CI: 27.0–46.8 %, p<0.001). Diagnostic momentum accounted for 52 % (48/92) of errors under incorrect diagnoses.While the timing of working diagnosis disclosure did not significantly alter diagnostic accuracy during ED handoffs, exposure to incorrect diagnoses markedly increased error rates. These findings underscore the imperative to refine diagnostic skills and reconsider ED handoff protocols to mitigate cognitive biases and optimize patient care outcomes. [ABSTRACT FROM AUTHOR]

As part of the Supporting Pediatric Research Outcomes Utilizing Telehealth (SPROUT) collaboration, three institutions (University of California, Davis, Childrens Hospital Colorado, and Childrens Hospital of Philadelphia) sought to improve communication with primary care providers (PCPs) using telehealth. This project connected families of neonatal intensive care unit (NICU) patients, their PCPs, and their NICU team through telehealth to provide an enhanced hospital handoff. This case series reports four cases that exemplify the benefits of these enhanced hospital handoffs: Case 1: assisting with changing care plans after NICU discharge, Case 2: demonstrating physical findings, Case 3: incorporation of additional subspecialties through telehealth, Case 4: arranging care for remote patients. Although these cases demonstrate some of the potential benefits of these handoffs, further study is needed to determine acceptability of these handoffs and to see whether they impact patient outcomes.

Background: Handling, transferring, and handing off trauma patients impose risks on patients and transfer teams. Therefore, pre-hospital staffs require a high skill to perform these processes simultaneously in critical situations.Aim: The present study was performed with aim to examine the role of demographic factors and skills of pre-hospital staff in the handling and movement of trauma patients to hospitals.Method: This cross-sectional study was performed by the proportional stratified random sampling method on 151 pre-hospital emergency staff. For data collection, in addition to a demographic information questionnaire, the researcher completed a valid and reliable checklist based on 300 hours of direct observation for assessing staff skills. The data were analyzed by SPSS software (version 20) using descriptive and inferential statistics. p

AbstractBackgroundMethodsResultsConclusionsImplementation science presents ethical issues not well addressed by traditional research ethics frameworks. There is little empirical work examining how clinicians whose work is affected by implementation studies view these issues. Accordingly, we interviewed clinicians working at sites participating in an implementation study seeking to improve patient handoffs to the intensive care unit (ICU).We performed semi-structured interviews with 32 clinicians working at sites participating in an implementation study aiming to improve patient handoffs from the operating room to the ICU. We analyzed the interviews using an iterative coding process following a conventional content analysis approach.Clinicians’ greatest concern about involvement was possible damage to interpersonal relations with more senior clinicians. They were divided about whether informed consent from clinicians was necessary but were satisfied with the study’s approach of sending out mass communications about the study. They did not think opting out of the implementation portion of the study was feasible but saw this inability to opt out as unproblematic because they equated the study with routine quality improvement. Those clinicians who helped launch the study at their sites recounted several different ways of doing so beyond simply facilitating access.The risks that clinicians identified stemmed more from their general status as employees than their specific work as clinicians. Implementation researchers should be attuned to the ethical ramifications of involving employees of varying ranks. Implementation researchers using hybrid designs should also be sensitive to the possibility that practitioners affected by a study will equate it with quality improvement and overlook its research component. Finally, the interactions that go into facilitating an implementation study are more various than the “gatekeeping” typically discussed by research ethicists. More research is needed on the ethics of the myriad interactions that are involved in making implementation studies happen. [ABSTRACT FROM AUTHOR]

BACKGROUND: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. OBJECTIVE: To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. DESIGN: Prospective Type 2 Hybrid effectiveness implementation study. SETTINGS AND PARTICIPANTS: Residents from diverse specialties across 32 hospitals (12 community, 20 academic). INTERVENTION: External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. MAIN OUTCOME AND MEASURES: Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. RESULTS: 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p

Introduction: Handoffs between the operating room (OR) and post-anesthesia care unit (PACU) require a high volume and quality of information to be transferred. This study aimed to improve perioperative communication with a handoff tool. Methods: Perioperative staff at a quaternary care center was surveyed regarding perception of handoff quality, and OR to PACU handoffs were observed for structured criteria. A 25-item tool was implemented, and handoffs were similarly observed. Staff was then again surveyed. A multidisciplinary team led this initiative as a collaboration. Results: After implementation, nursing reported improved perception of time spent (2.63-3.68, p 5 .02) and amount of information discussed (2.85-3.73, p 5 .05). Anesthesia also reported improved personal communication (3.69-4.43, p 5 .004), effectiveness of handoffs (3.43-3.82, p 5 .02), and amount of information discussed (4.26-4.76, p 5 .05). After implementation, observed patient information discussed during handoffs increased for both surgical and anesthesia team members. The frequency of complete and near-complete handoffs increased (40%-74%, p, .001). Conclusions: A structured handoff tool increased the amount of essential information reported during handoffs between the OR and PACU and increased team members' perception of handoffs. [ABSTRACT FROM AUTHOR]

Background. Bedside nursing handover is a recognized nursing practice that involves conducting shift change communication at the patient's bedside to enhance communication safety. Understanding the perceptions of both patients and nurses regarding bedside handover is crucial in identifying the key principles for developing and implementing effective bedside handover protocols. However, there is currently a lack of comprehensive evidence that summarizes and evaluates studies focused on qualitative approaches for gaining insights into the perceptions of both nurses and patients. Purpose. This meta-synthesis review aims to identify, synthesize, and evaluate the quality of primary qualitative studies on the perceptions of patients and nurses about bedside nursing handover. Methods. A meta-synthesis review was conducted to identify qualitative studies that reported patients and nurses' perceptions about bedside handover using seven electronic databases, including CINAHL, PsycINFO, Embase, Education Database (ProQuest), Web of Science, The Cochrane Library, and PubMed, from January 2013 to November 2023. The authors independently selected reviews, extracted data, and evaluated the quality of included studies using the 10-item JBI Qualitative Assessment and Review Instrument tool. Results. A total of 871 articles were retrieved, of which 13 met the inclusion and exclusion criteria. These studies identified three main themes: (1) facilitators of bedside nursing handover, (2) barriers to bedside nursing handover, and (3) strategies to maintain confidentiality during bedside handover. Conclusion. This study systematically reviewed and integrated the perceptions of patients and nurses about bedside handover. Based on nurses' perceptions, the combined findings highlight the facilitators of bedside handover, including developing partnership interaction between nurses and patients, promoting professionalism, and enhancing emotional communication among nurses. From the patients' viewpoint, the synthesized findings emphasize the facilitators of bedside handover, including acknowledging the expertise, professionalism, and humanity of the nursing profession, ensuring a sense of safety, satisfaction, and confidence in the care received, as well as promoting individualized nursing care. In the context of barriers to bedside handover, both nurses and patients perceive breaches of confidentiality and privacy violations as significant barriers. When it comes to maintaining confidentiality during bedside handovers, it is important to consider patients' preferences. Patients often prefer handovers to take place in a private setting. From the nurses' perspective, it is important to inquire with patients about their preference for the presence of caregivers, and to conduct private handovers for sensitive issues away from the bedside. Relevance to Clinical Practice. Clinicians should carefully evaluate the barriers and facilitators in this meta-synthesis prior to implementing bedside handover. Study Registration. This study is registered in PROSPERO with Protocol registration ID: CRD42024514615. [ABSTRACT FROM AUTHOR]

Background: The diagnostic process is a dynamic, team-based activity that is an important aspect of ward rounds in teaching hospitals. However, few studies have examined how academic ward teams operate in areas such as diagnosis in the handoff of overnight admissions during ward rounds. This study draws key lessons from team interactions in the handoff process during ward rounds. Objective: To describe how ward teams operate in the handoff of patients admitted overnight during ward rounds, and to characterize the role of the bedside patient evaluation in this context. Design: A qualitative ethnographic approach using field observations and documentary analysis. Participants: Attending physicians, medical residents, and medical students on general medicine services in a single teaching hospital. Approach: Thirty-five hours of observations were undertaken over a 4-month period. We purposively approached a diverse group of attendings who cover a range of clinical teaching experience, and obtained informed consent from all ward team members and observed patients. Thirty patient handoffs were observed across 5 ward teams with 45 team members. We conducted thematic analysis of researcher field notes and electronic health record documents using social cognitive theories to characterize the dynamic interactions occurring in the real clinical environment. Key Results: Teams spent less time during ward rounds on verifying history and physical examination findings, performing bedside evaluations, and discussing differential diagnoses than other aspects (e.g., reviewing patient data in conference rooms) in the team handoff process of overnight admissions. Several team-based approaches to diagnosis and bedside patient evaluations were observed, including debriefing for learning and decision-making. Conclusions: This study highlights potential strengths and missed opportunities for teaching, learning, and engaging directly with patients in the ward team handoff of patients admitted overnight. These findings may inform curriculum development, faculty training, and patient safety research. [ABSTRACT FROM AUTHOR]

Introduction The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military–civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams. Materials and Methods BIDMF had several two-person teams who monitored handoff procedures between military assets after decontamination and civilian emergency medical services providers during the exercise evaluation. Results A verbal handoff between military and civilian entities was usually not done. Triage tags placed on mannequins before decontamination remained attached to the bodies and were sent with them to civilian hospitals. Triage tags were generic military forms without specific radiation or chemical exposure information. Not all decontamination groups had the same medical capabilities, and in a disaster it is unclear how these teams would manage medical emergencies. Conclusions Future studies should develop a standardized handoff procedure to be used in mass casualty situations, and trial it in future multi-agency disaster exercises. Radiation specific triage tags should be considered. [ABSTRACT FROM AUTHOR]

Through an urgent patient case of acute limb ischemia and intervention, care transitions are examined. The importance of safe, consistent transitions of care has become even more apparent after the COVID-19 pandemic when face-to-face communication was inhibited in many areas. The impact of urgent patient needs coupled with a high number of inexperienced staff enhances the need for appraisal of current handoff communication practices in all patient care areas. The reality is this; many of the most serious medical errors are linked to miscommunication. This ischemic limb patient case highlights inconsistencies in patient care transition processes and the associated risks that need to be addressed to improve patient care. • An average 5-day inpatient hospital stay include - ten to twelve patient hand-off interactions. Eighty percent of serious errors occur due to miscommunication. • The literature points to the importance of standardized hand-off practices and reporting tools to ensure less errors. • Reevaluation of communication practices after the COVID-19 pandemic may improve patient care. • Clear, consistent communication practices across the care continuum provide less room for errors. [ABSTRACT FROM AUTHOR]

Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (−1.1 ml/kg predicted body weight [IQR, −2.0 to −0.2]; P < 0.001; and −4.3 cm H2O [−8.2 to −1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [−1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06–1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4–1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality. [ABSTRACT FROM AUTHOR]

Introduction: Poor reporting during patient handoff from emergency medical technicians to the emergency department can threaten patients’ safety. This study aimed to determine the effect of training on the quality of patient handoff from emergency medical technicians to the emergency department of the surgical emergency center.Methods: This quasi-experimental study was conducted at Shahid Rajaee Surgical Emergency Center in Shiraz, Iran. The study sample included 80 emergency medical technicians with a mean age of 31.12±6.2 years, who were selected by simple random sampling and divided into two experimental and control groups by permuted block randomization. Data were collected by observing the handoff of three patients by each technician before and after the intervention with a rating scale developed by the researchers. The intervention consisted of a 4-hour training workshop about principles of patient reporting and handoff for emergency medical technicians. Data analysis was performed using descriptive statistics, chi-square, independent, and paired sample t-tests using SPSS version 20. The significance level was less than 0.05.Results: After the intervention, the mean score of patient handoff quality in the experimental group (29.94±2.73) compared to before the intervention (24.58±3.38, P

Background: Patient handover (handoff in America) is the transfer of information and accountability among nurses assigned to patient care. Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) is currently the most popular framework for framing handovers. However, research shows that incomplete handovers and information transfers among healthcare providers and nurses exist and are responsible for adverse patient events. Materials and Methods: The current systematic review aims to view contemporary literature on handover, especially but not exclusively in psychiatric settings, and to extract current conditions from Electronic Patient Records (EPRs) using the ISBAR framework. A total of fifty-five scientific papers were selected to support the scoping review. Eligibility criteria included structured research to analyze outcomes, completed by reviewing policy papers and professional organization guidelines on I/SBAR handovers. Results: Our systematic review shows that the application of ISBAR increases interprofessional communication skills and confidence and the quality of the transfer of clinical information about patients, resulting in increased patient safety and quality of care. Conclusions: Implementing the knowledge and application of structured patient handover will respond to current recommendations for service improvement and quality of care. Furthermore, nurses who use ISBAR also reported its benefits as they feel they can deliver what is required for patient care information in a structured, fast, and efficient way. A further increase in the efficacy of handovers is reported by using EPR.

While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.

BackgroundRacial/ethnic minority survivors of domestic violence (DV) referred from emergency departments (EDs) face barriers connecting with advocacy services due to systemic inequities. This study assesses the impact of Domestic Violence Report and Referral (DVRR), a digital mandatory reporting compliance system with integrated direct-to-advocacy referrals sent with patient consent, on survivors' likelihood of receiving advocacy by race/ethnicity and gender.MethodsWe assessed ED charts between 2014-2018 in an urban, Level 1 trauma center for DV-related positive screening, chief concern, or documentation in medical/social work notes. We matched these visits by name to local DV advocacy agency records. Using logistic regression, we assessed survivor odds of reaching advocacy by DVRR receipt, race/ethnicity and gender. We used predicted probabilities to identify between-group differences in advocacy services received.ResultsOf the 1366 visits, 740 received the DVRR intervention; 323 received advocacy services Without DVRR, compared to white, female survivors (n = 87), male survivors (n = 132) had 0.20 (95% CI: 0.07-0.56) times the odds of reaching advocacy compared to female survivors; Latinx survivors (n = 136) had 2.53 (95% CI: 1.58-4.07) times the odds of reaching advocacy compared to white survivors. With DVRR, the odds and predicted probabilities of reaching advocacy increased significantly for all survivors. White, female survivors (n = 74) who received DVRR experienced 2.60 (95% CI: 1.66-4.07) times the odds of connecting with advocacy. Compared to this reference group, Black survivors (n = 480) who received DVRR experienced 4.66 additional times the odds of reaching advocacy services (95% CI: 3.09-7.04) and male survivors (n = 84) experienced 8.96 additional times the odds (95% CI: 2.81-28.56). Overall, we predict 43% (95% CI: 38-53%) of Latinx survivors (n = 177), 36% (95% CI: 31-40%) of Black survivors (n = 480) and 23% (95% CI: 14-32%) of white survivors (n = 83); 37% (95% CI: 33-40%) of women (n = 656) and 29% (95% CI: 18-42%) of men (n = 84) received advocacy services with DVRR.ConclusionDirect-to-advocacy ED referrals facilitated by eHealth technology improve access to advocacy care for all survivors in this sample; marginalized racial and ethnic groups most often victimized by DV appear to have the highest rates of connection to advocacy.

Paulo Cruchinho, Gisela Teixeira, Pedro Lucas, Filomena Gaspar Nursing Research, Innovation and Development Centre (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, 1600-190, PortugalCorrespondence: Paulo Cruchinho, Nursing School of Lisbon, Avenida Prof. Egas Moniz, Lisboa, 1600-190, Portugal, Tel +351 217913400, Email pjcruchinho@esel.ptAbstract: Nurse managers need culturally adapted assessment instruments to support the implementation of change to Nursing Bedside Handover (NBH) in healthcare institutions. This study aimed to cross-culturally adapt the Bedside Handover Attitudes and Behaviours (BHAB) questionnaire to the Portuguese context and evaluate the methodological approaches used for this purpose. To guide this study, we followed a guideline for cross-cultural translation and adaptation measurement instruments in healthcare. The results of the content validity testing suggested that the BHAB questionnaire is a valid instrument for use in the Portuguese context. To obtain these results we showed 1) using of a new methodological approach, the dual focus, to resolve the divergences and ambiguities in the translators’ committee and the multi-professional committee; 2) the lack of a conceptual definition of the construct of the instrument as a requirement to retain items with I-CVI < 0.70 after validity relevance pretesting and 3) the cognitive debriefing and relevance pretesting as methodological approaches which can be used alone or together to reinforce the evaluation of cultural relevance of the items. We concluded there is a need for guidelines to support the decision-making process of healthcare researchers with comprehensive information about the different methodological approaches they can follow.Keywords: patient handoff, nursing, questionnaire, translation, validity, methodological study

Introduction: Poor reporting during patient handoff from emergency medical technicians to the emergency department can threaten patients’ safety. This study aimed to determine the effect of training on the quality of patient handoff from emergency medical technicians to the emergency department of the surgical emergency center. Methods: This quasi-experimental study was conducted at Shahid Rajaee Surgical Emergency Center in Shiraz, Iran. The study sample included 80 emergency medical technicians with a mean age of 31.12±6.2 years, who were selected by simple random sampling and divided into two experimental and control groups by permuted block randomization. Data were collected by observing the handoff of three patients by each technician before and after the intervention with a rating scale developed by the researchers. The intervention consisted of a 4-hour training workshop about principles of patient reporting and handoff for emergency medical technicians. Data analysis was performed using descriptive statistics, chi-square, independent, and paired sample t-tests using SPSS version 20. The significance level was less than 0.05. Results: After the intervention, the mean score of patient handoff quality in the experimental group (29.94±2.73) compared to before the intervention (24.58±3.38, P<0.001) and compared to the control group (23.94±2.83, P<0.001) was significantly higher. Conclusion: The findings showed that reporting training to emergency medical technicians can help to improve the quality of their patients’ handoff to emergency departments. [ABSTRACT FROM AUTHOR]

Introduction: Long considered a danger point in patient care, handoffs and patient care transitions contribute to medical errors and adverse events. Without standardization of patient handoffs, communication breakdowns arise and critical patient information is lost. Minimal training and informal learning have led to a lack of understanding the process involved in this vital aspect of patient care. In 2017, the U.S. Army commissioned a report to study the process of patient handoffs and identify training gaps. Our report summarizes that process and makes recommendations for implementation. Materials and Methods: Scoping literature review of 139 articles published between 1999 and 2017 using PubMed, CINAHL, Cochrane, and Medline databases. Verbal tools for handoffs were evaluated against 12 criteria including patient ID, history, current situation, contingency planning, ability to ask questions, ownership, and read back. Written tools were evaluated against a matrix of 126 casualty/treatment attributes. Results: Among verbal communication protocols, the highest scoring handoff mnemonics were HAND ME AN ISOBAR, IPASS the BATON, and I-SBARQ. Among written handoff tools, the highest scoring documents were the Special Operations Forces (SOF) Mechanism, Injuries, Signs, and Treatment (MIST) Casualty Treatment Card and the Department of Defense (DD) Form 1380 Tactical Combat Casualty Care (TCCC) Card. Four critical process elements for patient handoffs and transfers were identified: (1) interactive communications, (2) limited interruptions, (3) a process for verification, and (4) an opportunity to review any relevant historical data. Conclusions: The findings in this review highlight the need for standardized tools and techniques for patient handoffs in the U.S. Military's expeditionary care system. Future research is needed to trial verbal and nonverbal handoffs under field conditions to gather observational data to assess effectiveness. The results of our gap analyses may provide researchers insight for determining which handoffs to study. If standardized handoffs are utilized, training programs should incorporate the four critical elements into their curricula. [ABSTRACT FROM AUTHOR]

Background: Patient handover (handoff in America) is the transfer of information and accountability among nurses assigned to patient care. Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) is currently the most popular framework for framing handovers. However, research shows that incomplete handovers and information transfers among healthcare providers and nurses exist and are responsible for adverse patient events. Materials and Methods: The current systematic review aims to view contemporary literature on handover, especially but not exclusively in psychiatric settings, and to extract current conditions from Electronic Patient Records (EPRs) using the ISBAR framework. A total of fifty-five scientific papers were selected to support the scoping review. Eligibility criteria included structured research to analyze outcomes, completed by reviewing policy papers and professional organization guidelines on I/SBAR handovers. Results: Our systematic review shows that the application of ISBAR increases interprofessional communication skills and confidence and the quality of the transfer of clinical information about patients, resulting in increased patient safety and quality of care. Conclusions: Implementing the knowledge and application of structured patient handover will respond to current recommendations for service improvement and quality of care. Furthermore, nurses who use ISBAR also reported its benefits as they feel they can deliver what is required for patient care information in a structured, fast, and efficient way. A further increase in the efficacy of handovers is reported by using EPR. [ABSTRACT FROM AUTHOR]

The quality of emergency medical services remains a major public health issue in developing countries in terms of access, availability, or timely delivery, owing to high socio-economic and ethnic disparities. Particularly, the timeliness of EMS remains a drawback, leading to higher mortality and morbidity. The aim of the study is to assess the district-level differences and factors that influence ambulance travel time, as there was no study done in the Indian scenario. Sequential Explanatory Design was applied here, which involved a descriptive study and spatial analysis of the call volume and distribution to understand the operational challenges of MEMS, followed by in-depth interviews among medical officers and officials to explore the reasons for the challenges. The data, shared by the Department of Health, Government of Maharashtra, consisted of 38,823 records (emergency: 16,197 and hospital-to-hospital transfer: 22,626), including emergency and hospital-to-hospital transfer calls across 36 districts of Maharashtra for November 2022. Spatial analyses were performed to identify the districts with challenges of timeliness. The average ambulance response time (T) across the districts was reported at 134.5 min for emergency cases and 222.80 min for hospital-to-hospital transfer cases. The total ambulance response time, was classified as preparation time (t1:3.53 min for emergency, 3.69 min for hospital-to-hospital transfer), travel time from base to scene (t2: 23.15 min for emergency, 17.18 min for hospital-to-hospital transfer), time required at scene (t3: 12.12 min for emergency, 14.72 min for hospital-to-hospital transfer), travel time from scene to hospital (t4:39.41 min for emergency, 74.34 min for hospital-to-hospital transfer), patient handover time (t5: 10.85 min for emergency, 13.84 min for hospital-to-hospital transfer), and return from base to hospital (t6: 41.89 min for emergency, 94.72 min for hospital-to-hospital transfer). Multivariate linear regression was conducted to investigate the factors that influence ambulance travel time. The finding identifies that the ambulance travel time increased for the districts with lesser population density, lower road density, fewer hospitals, a higher district area served per ambulance, and a higher population served per ambulance. Additionally, socio-cultural reasons affecting health-seeking behaviour, early closing of healthcare centres, undercapacity and resource-deficit healthcare centres, and overloading of specialised tertiary hospitals were identified as determinants of delay in patient assessment and handover time in qualitative findings. A decisive and multi-sectoral approach is required to address the timeliness of EMS in the Indian context. [ABSTRACT FROM AUTHOR]

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Osteoporotic fractures among long-term care residents have substantial economic and human costs. After a fracture, many older adults do not receive an osteoporosis diagnosis or evidence-based treatment, which leads to increased risk of recurrent fractures. Optimal processes are well defined for transitioning medical care after a hip or vertebral fracture for osteoporosis evaluation, but the handoff process from the specialist back to a primary care practitioner (PCP) or to a rehabilitative setting is not well defined. Our interdisciplinary quality improvement team developed and evaluated a program for transitioning care from a hospital-based fracture liaison clinic (FLC) to PCPs caring for older adults across the care continuum. To understand the current process of postfracture care transitions, we analyzed the postfracture patient experience. We surveyed PCPs to assess barriers to osteoporosis treatment, and retrospectively conducted a baseline analysis of 87 patients who had sustained an osteoporotic fracture in 2020. This preliminary work showed several opportunities for practice improvement and helped us develop a practical multicomponent intervention aimed at improving care transitions from the FLC to PCPs. The intervention (June-September 2021) comprised a standardized documentation template in the electronic health record (EHR) for FLC clinicians, a structured handoff process, and an engagement tool for patients outlining the roles and responsibilities of each care team member. We compared care transition measures before and after intervention. EHR documentation of an osteoporosis diagnosis increased from 56% (49 of 87 patients) before intervention to 92% (48 of 52) after intervention (P <.001). Additionally, increases were observed in documentation of treatment recommendations, associated risk factors, and PCP discussions with patients regarding osteoporosis and related treatment. This practical, commonsense intervention established clear roles for each care team member. The intervention addressed systemwide barriers in facilitating a safe transition from a subspecialty care team to PCPs providing care to older adults with osteoporosis. [ABSTRACT FROM AUTHOR]

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and examine the effectiveness of the stepwise handoff protocol based on the situation, background, assessment, recommendation (SBAR) application for long-term care hospital nurses. Methods: A nonequivalent control group pre-posttest design was used for this study. There were 23 subjects in the experimental group and 23 subjects in the control group. Using SPSS Statistics 21.0, data were analyzed by descriptive statistics, independent t-test, and repeated measure ANOVA. Results: The effectiveness of the stepwise handoff protocol based on the SBAR for long-term care hospital nurses showed a difference in the communication self-efficacy by group (F=8.81, p=.005), by time (F=11.43, p<.001), the interaction effect of group point and time (F=9.67, p<.001), the communication clarity by group (F=10.05, p=.003), by time (F=5.74, p=.005), interaction effect between group point and time (F=3.37, p=.039), and the quality of handoff by group (F=12.48, p=.001), by time (F=7.03, p=.010), and interaction effect between group point and time (F=4.29, p=.042). Conclusion: The stepwise handoff protocol based on the SBAR is expected to improve the work by systematically implementing the transfer of long-term care hospital nursing to increase nurses’ job efficiency. [ABSTRACT FROM AUTHOR]

BACKGROUND: Good communication is necessary for safety and quality of health. This study aims to determine the effect of ISBAR communication on nurses' perception of communication and attitudes toward patient safety in the Emirates Maternity Hospital in the Gaza Strip, Palestine METHOD: A single-group hospital-based intervention study (pre and posttest) was conducted. A census sample was used. Participants opinions about the effect of ISBAR were gathered using two tools established by Shortell, Rousseau, Sexton, and Helmreich to assess the communication awareness and nurses' attitudes towards safety, respectively, before and after the use of the ISBAR program. RESULTS: After the ISBAR application, nurses' perception of communication demonstrated a positive and significant increase in the three sub-items (openness, accuracy and understanding, and shift communication) in the nurse-nurse communication. Moreover, in four sub-items (openness, accuracy, and understanding, timeliness, and satisfaction) in nurse-doctor communication, (p = 0.05). Further, the nurses' attitudes toward patient safety showed a significant and positive increase in teamwork climate (p=0.001), safety climate (p = 0.007), job satisfaction and working condition (p=0.001), stress recognition (p = 0.008), and perception of management (p = 0.001). CONCLUSION: The results provide significant evidence of the positive effects of the ISBAR program in improving nurses' perceptions of communication and attitudes toward patient safety. It is recommended that healthcare providers use ISBAR communication in their practice. Moreover, periodic training programs are required for effective ISBAR communication among the healthcare team. [ABSTRACT FROM AUTHOR]

Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians.

ObjectiveTo develop an interfacility transfer handoff intervention by applying the person-based approach method.MethodsWe conducted a qualitative study that used nominal group technique (NGT) and focus groups to apply the person-based approach for intervention development. NGT methods were used to determine prioritized pediatric transfer handoff elements to design the initial intervention prototype. Five focus group sessions were then held to solicit feedback on the intervention, perceptions on implementing the intervention, and outcomes for evaluating the intervention. Data were analyzed by using content analysis. Iterative improvements were made to the intervention prototype as data emerged.ResultsForty-two clinical providers in total participated in NGT and focus group sessions, including physicians, advanced practitioners, nurses, and a respiratory therapist. The initial intervention prototype was a handoff mnemonic tool, "SHARING" (short introduction, how the patient appeared, action taken, responses and results, interpretation, next steps, gather documents). Perceived benefits of the intervention included clarifying handoff expectations, reducing handoff deficits, supporting less experienced clinical providers, and setting the stage for ongoing effective communication. Outcomes perceived to be meaningful were related to triage appropriateness, workflow and use, and communication and information sharing. The final version of the intervention consisted of a SHARING reference card and a SHARING electronic medical record note template.ConclusionsUsing qualitative methods to apply the person-based approach to intervention development, we developed a transfer handoff intervention. Future research is needed to examine impacts of this tool; outcomes can include those identified as meaningful by participants in our present study.

IntroductionThe I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training.MethodsThe I-PASS Mentored Implementation Handoff Curriculum frontline provider training materials were created as part of the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach with an emphasis on adult learning theory principles. The training includes an overview of I-PASS handoff techniques, TeamSTEPPS team communication strategies, verbal handoff simulation scenarios, and a printed handoff document exercise.ResultsAs part of the SHM I-PASS Mentored Implementation Program, 2,735 frontline providers were trained at 32 study sites (16 adult and 16 pediatric) across North America. At the end of their training, 1,762 frontline providers completed the workshop evaluation form (64% response rate). After receiving the training, over 90% agreed/strongly agreed that they were able to distinguish a good- from a poor-quality handoff, articulate the elements of the I-PASS mnemonic, construct a high-quality patient summary, advocate for an appropriate environment for handoffs, and participate in handoff simulations. Universally, the training provided them with knowledge and skills relevant to their patient care activities.DiscussionThe I-PASS frontline training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.

Background: Patient handover in the emergency department (ED) is a 2-way communication process between the paramedics and in-hospital emergency personnel, which can result in miscommunication and delivery challenges. This study aimed to explore the lived experience of paramedics on patient handover to the ED. Methods: Over a period of 5 months, an interpretative phenomenological analysis (IPA) was used to explore the lived experiences of 15 paramedics in Tabriz, Iran. Semi-structured interviews were conducted in the emergency medical stations using the Smith approach for data collection and analysis. The researcher used 4 criteria to ensure rigor, including credibility, dependability, confirmability, and transferability, according to Lincoln and Guba. Results: Three main themes emerged from the data analysis, including “the hole of hope,” “the boring issues,” and “paramedics are only a driver.” A further 11 sub-themes emerged under the main themes. Conclusion: The highlighted issues that need to be considered during the process are the presence of staff in front of the ED's door to welcome the patient, removal of structural defects and defective hospital equipment, the presence of medical supplies in emergency triage to prevent the paramedics from stumbling, and listening to paramedics by physicians and nurses to obtain the patients’ history.

Emergency medical services (EMS) to emergency department (ED) handoffs are important moments in patient care, but patient information is communicated inconsistently. The aim of this study was to describe the duration, completeness, and communication patterns of patient handoffs from EMS to pediatric ED clinicians. We conducted a video-based, prospective study in the resuscitation suite of an academic pediatric ED. All patients 25 years and younger transported via ground EMS from the scene were eligible. We completed a structured video review to assess frequency of transmission of handoff elements, handoff duration, and communication patterns. We compared outcomes between medical and trauma activations. We included 156 of 164 eligible patient encounters from January to June 2022. Mean (SD) handoff duration was 76 (39) seconds. Chief symptom and mechanism of injury were included in 96% of handoffs. Most EMS clinicians communicated prehospital interventions (73%) and physical examination findings (85%). However, vital signs were reported for fewer than one-third of patients. EMS clinicians were more likely to communicate prehospital interventions and vital signs for medical compared with trauma activations (p < 0.05). Communication challenges between EMS clinicians and the ED were common; ED clinicians interrupted EMS or requested information already communicated by EMS in nearly one-half of handoffs. EMS to pediatric ED handoffs take longer than recommended and frequently lack important patient information. ED clinicians engage in communication patterns that may hinder organized, efficient, and complete handoff. This study highlights the need for standardizing EMS handoff and ED clinician education regarding communication strategies to ensure active listening during EMS handoff. [ABSTRACT FROM AUTHOR]

Introduction: The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. Methods: MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. Results: A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. Conclusion: The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive. [ABSTRACT FROM AUTHOR]

Background: Safe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions. Methods: Using a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees' experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses. Results: 687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame. Conclusions: Health systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment. [ABSTRACT FROM AUTHOR]

Introduction: Jean Watson's theory of caring is committed to holistic care through a helping relationship between patient and caregiver. The "bedside shift report" methodology actively involves the patient in the transfer of information between health professionals, especially in hostile contexts (such as intensive care units) for communication and humanization of care. Objective: to explore the perceptions of patients who participated in the transfer of information at the bedside in an intensive care unit, from Jean Watson's theory of caring. Methodology: narrative analysis of the interviews carried out through the conceptual-theoretical-empirical system (CTES) based on Jean Watson's caring theory. The empirical-rational method was combined through an inductive approach. Results: The four patients interviewed expressed perceptions inherent to the assumptions and care factors of the caring Theory: interpersonal relationship and health promotion (they facilitate trust and empowerment); adequate environment for personal development (improve transparency and satisfaction); patient as the central axis of nursing (increases the effectiveness and safety of care). Conclusions: The importance of including the patient in the transfer of information allows him to be the central axis of her care. This allows you to grow and promote your health, thanks to the environment of trust created and/or the communicative symbiosis between the participants. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To develop and validate a prototype of a mobile application shift handover between nurses in the emergency room using a severity scale. Method: This is a technological tool carried out at the Universidade Estadual de Maringá using design thinking, divided into four phases: discovering, defining, developing, and delivering. To structure the information, a checklist was used based on the Situation Background Assessment Recommendation, and to categorize patients in terms of severity, the National Early Warning Score was used. The validation of the sample was carried out by 10 nurses, specialized in the field of urgency and emergency, using the System Usability Scale questionnaire to assess usability. The content validity coefficient was used for analysis. Results: The application scored 75.75 in usability and had a content validity coefficient of 0.8. Conclusion: The prototype obtained an excellent evaluation of usability and agreement between evaluators. Future studies are needed for implementation in practice, evaluating the practicality, applicability, efficiency and time savings in shift information transfer.

ObjectiveTo compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone.DesignCross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis.SettingTertiary PICU within an academic children's hospital.ParticipantsPICU nurses who received a patient handoff between October 2017 and July 2018.InterventionsNone.Main results and measurementsAmong 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55).ConclusionsTelemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

Abstract Introduction When handover is conducted at the patient's bedside, active patient participation can be encouraged, which may improve the safety and quality of care. There is a need for valid and reliable tools to measure patient perceptions of participation in bedside handover, to ensure the rising number of implementation and improvement efforts are consistently and effectively evaluated. The aim of this study is to systematically develop and evaluate the psychometric properties of a self‐report survey to measure patients' perceptions of participation in bedside handover. Methods In Phase 1, our team developed a conceptual framework and item pool (n = 130). In Phase 2, content validity was assessed with four health consumers, four nurses and four researchers. Next, 10 current hospital inpatients tested the survey for end‐user satisfaction. In Phase 3, 326 inpatients completed the survey, allowing exploratory factor analysis, reliability analyses and convergent/divergent validity analyses to occur. Results Phase 1 and 2 resulted in a 42‐item survey. In Phase 3, 321 surveys were available for analysis. Exploratory factor analysis revealed a three‐factor solution, with 24 items, which matched our conceptual framework. The three factors were: ‘Conditions for patient participation in bedside handover’, ‘Level of patient participation in bedside handover’ and ‘Evaluation of patient participation in bedside handover’. There was strong evidence for factor reliability and validity. Additionally, the correlation between factors was strong. Conclusion This study furthers our conceptual understanding by showing that nurse facilitating behaviours are a strong precursor for patient participation and perceived handover outcomes, justifying the need for nursing training. A robust survey has been developed to measure patient perceptions of participation in bedside handover, which can effectively evaluate this approach to care. Engaging consumers and nurses as research team members was invaluable in ensuring that the survey is acceptable for end‐users. Patient or Public Contribution A health consumer and nurse partnered as members of the research team from study inception to dissemination.

Background: It is currently under discussion whether Learner Handovers (LH) are beneficial, disadvantageous, or useful in Health Professions Education. Research has not been conducted to determine the extent of existing informal learner handover (ILH) through faculty discussions. In addition to providing stakeholders with added context, examining the nature of ILH may also provide insight into the bias associated with Learner Handover. Methods: Transcripts from a series of semi-structured Focus Group Discussions (FGDs) and interviews (from January to March 2022) were iteratively reviewed to identify relevant patterns and correlations. The study involved the voluntary participation of 16 active clinical dental faculty members with a variety of designations. We did not discard any opinions. Results: It was found that ILH had a mild impact on students' training. ILH effects can be categorized into four key areas: (1) faculty behavior with students, (2) faculty expectations from students, 3) teaching approach, and 4) faculty feedback practices. Furthermore, five additional factors were identified as having a greater influence on ILH practices. Conclusions: In clinical dental training, ILH has a minor effect on faculty-student interactions. Faculty perceptions and ILH are strongly influenced by other factors contributing to the student's 'academic reputation. As a result, student-faculty interactions are never free of prior influences, so stakeholders need to take them into consideration when creating a formal LH. [ABSTRACT FROM AUTHOR]

Introduction: The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD-a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response.Materials and Methods: This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants' experiences while deployed to NYC. These interview scripts were then independently coded by five research team members.Results: We identified four common themes and 12 subthemes from the participants' responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military-civilian liaison service, positive experience, and military support necessity).Conclusions: This study provides unique insight into the DoD's initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD's pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future. [ABSTRACT FROM AUTHOR]