Junior Doctor Perceptions of Clinical Handover

the impact of efficiency, education and senior clinician facilitation Dr Hamish Dunn Dr Joanna Dargan Dr Lucy Cho

• • • • •

Background

Role of poor communication in sentinel events Increasing international focus Need for structural and organizational support WHY JMOs?

– Inexperienced – Communication quality and content – Lack of standardised protocols – Fatigued clinicians Paucity of evidence – especially from JMO perspective

Methods

• • • Qualitative study –

JMO-led focus groups

–

semi-structured individual interviews

in-depth supplement to the broader concept evaluation of the NSW Acute Care Taskforce: JMO Clinical Handover Project

Thematic analysis

consensus framework

45

JMOs at

6

NSW Hospitals

Themes

1. Efficiency

– “It’s not always safest for us to come off the ward for handover.” [Intern] – flexible standardisation – ISBAR

2. Handover Tools

– “Once it’s on paper you have to do something about it.” [Intern] – Documentation not duplication

Themes

3. Education & Supervision

– “relieves that anxiety about your management” [Intern] – “Otherwise you get nothing on overtime” [RMO] – Education and feedback are the “selling points” [Intern] of the handover process

Handover facilitation guide for senior clinicians

1. Senior Clinicians’ handover input, feedback and teaching are highly valued by JMOs 2. Senior Clinician presence is critical to developing a strong handover culture in the hospital 3. Prompt arrival and attendance for the duration of handover is necessary 4. Accessibility and approachability of senior clinicians promotes learning

Handover facilitation guide for senior clinicians

5. Teach a 5-minute ‘clinical pearl’ when possible during handover 6. Review emergency team calls to critically unwell patients 7. Use the patients at handover as a stimulus to teaching 8. Give non-judgemental feedback on the management of unwell patients 9. Management suggestions on common clinical scenarios will improve patient care, help JMO confidence in clinical management, and reduce JMO anxiety at work

Themes

4. Patient safety and continuity of care

1. “Knowing the sick patients before they go off”

[Intern] 2. clearer guidance on complex patients making it “easier with the management plan” [Intern] 3. improved continuity of team management plans 4. education about optimal management of common clinical scenarios

Strengths & Weaknesses

• • Qualitative findings not yet quantitatively assessed ? generalisability ? observer bias • • • Marked consistency of themes across hospitals, rural to metroplitan First study to identify the motivational value of handover as a key element to sustainability JMO researchers

Relevance

• NSW Health reported that this data collected was most useful in handover project implementation • • Represented a shift in the paradigm for change – bottom up rather than top down For local implementation in consultation with your JMOs

Summary

• • JMOs feel that when shift-to-shift handover is –

Efficient,

–

Educational,

–

Facilitated by a senior clinician

it is effective in improving patient safety and continuity of care