Emergency physicians’ communication: What about a standardized handover?

In health care organizations, the need for 24-hour care increases the number of patient’s transfer. Handover and shift changes are now recognized as particularly critical moments for the reliability of care. However, few studies focused specifically on how physicians share relevant information during these moments. Moreover, emergency departments are known to be extremely vulnerable to error, because of high time pressure, frequent interruptions, high variability and number of patients, etc.
Our study aimed to estimate how emergency physicians share information about a patient during handover, and to evaluate the impact of a procedure of medical handover standardization. To do this, we conducted a pre-post test on completeness of transmissions.
We first performed observations of 50 physicians’ shift changes in an emergency department. All of these were video-recorded and then analyzed. We classified communications into seven categories (identifying information, current pathology, patient’s current status, significant patient’s tests results, priority medical interventions, diagnose and recommendations, and dispositions). After these observations, we elaborated and implemented a standardization procedure, according to literature, analyses of our observations and physicians’ recommendations. We finally assessed this procedure by observing and analyzing 40 handovers, using the same method as previously described. We also evaluated the physician’s opinion about the quality of the transmission with a 7-point Likert scale.
Our results showed three significant differences before and after the standardization of communications. Physicians share more information about patient’s tests results, priority interventions and dispositions. Moreover, we found a significant difference of the perceived quality of the standardized handover.