Post on 07-Apr-2018
8/3/2019 Improving Fandover Process
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Improving patient care
handover processes in Europe
Julie K. Johnson, MSPH, PhD
Academy Health Annual Research MeetingChicago, June 30, 2009
8/3/2019 Improving Fandover Process
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Why Study andImprove Handovers?Why Study andImprove Handovers?
Handovers are the Basis for transferring care of patients
across shifts and across care settings
Critical for maintaining continuity andsafety of patient care
A handover of patient care introduces a
“vulnerable gap” and may result inerrors, “near misses”, and adversepatient events
Handovers are the Basis for transferring care of patients
across shifts and across care settings
Critical for maintaining continuity andsafety of patient care
A handover of patient care introduces a
“vulnerable gap” and may result inerrors, “near misses”, and adversepatient events
8/3/2019 Improving Fandover Process
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Role of HandoversRole of Handovers
Exchange of vital information Shared mental models and cognition of
patient status
Exchange and uptake of responsibility
Part of the microsystem life-cycle
Vital to care giving unit, patients, andworkers survival
Exchange of vital information
Shared mental models and cognition ofpatient status
Exchange and uptake of responsibility Part of the microsystem life-cycle
Vital to care giving unit, patients, andworkers survival
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We’re Not the Only OnesWe’re Not the Only Ones
Handovers of patient care have become afocus of worldwide patient safetyimprovement efforts The World Health Organization (WHO) listed
“Communication during Patient CareHandovers” as one of its High 5 patient safetyinitiatives
Improving effective communication throughoutthe hospital is one of the patient safety goals ofthe Joint Commission International
Handovers of patient care have become afocus of worldwide patient safetyimprovement efforts The World Health Organization (WHO) listed
“Communication during Patient CareHandovers” as one of its High 5 patient safetyinitiatives
Improving effective communication throughoutthe hospital is one of the patient safety goals ofthe Joint Commission International
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Hospital to Community TransitionHospital to Community Transition
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Many Actors are InvolvedMany Actors are Involved
Means of assistance
Medical Service
Family
Physicians
Nurses
Medical Assistants
Home-help
service
Physiotherapist
Dietitian
Speechtherapist
Welfare officer
Social insurance office
Pharmacy
EMS
Economic & Adm.
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EU-7 GrantEU-7 Grant
3 year project to study handovers in 6countries, announced in April 2008 and
awarded in October 2008
This was the first time the EU has funded aproject on transitions of care.
A key driver was the movement of patients
across countries
3 year project to study handovers in 6countries, announced in April 2008 and
awarded in October 2008
This was the first time the EU has funded aproject on transitions of care.
A key driver was the movement of patients
across countries
8/3/2019 Improving Fandover Process
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Objectives of Eu FP-7 GrantObjectives of Eu FP-7 Grant
Understand safety of hand-over processes ina variety of settings and countries in EU
Develop and apply educational and
organizational strategies for safe andeffective handovers
Review and asses what we’ve learned abouthandovers in clinical settings
Disseminate the learning
Understand safety of hand-over processes ina variety of settings and countries in EU
Develop and apply educational andorganizational strategies for safe andeffective handovers
Review and asses what we’ve learned abouthandovers in clinical settings
Disseminate the learning
8/3/2019 Improving Fandover Process
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ParticipantsParticipants
The Netherlands University Medical Centre Utrecht
Centre for Learning Sciences and Technologies (OUNL)
Radboud University Medical Centre
Avedis Donabedian Institute, Autonomous Universityof Barcelona, Spain
University of Birmingham, United Kingdom
Azienda Sanitaria Firenze, Italy
Karolinska Institute, Sweden
National Centre for Quality Assessment inHealthcare, Poland
The Netherlands University Medical Centre Utrecht
Centre for Learning Sciences and Technologies (OUNL)
Radboud University Medical Centre
Avedis Donabedian Institute, Autonomous Universityof Barcelona, Spain
University of Birmingham, United Kingdom
Azienda Sanitaria Firenze, Italy
Karolinska Institute, Sweden
National Centre for Quality Assessment inHealthcare, Poland
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How are we learning abouthandovers in each setting?How are we learning abouthandovers in each setting?
Structured Interviews Focus Groups
Process analysis
Structured Interviews
Focus Groups
Process analysis
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Progress to DateProgress to Date
Three face to face meetings Monthly conference calls
Ethics approval in all the countries
Website for group work
Training in qualitative methods (Atlas course next week) Methods guide
Developed interview tools for patients, providers
Completed comprehensive literature review
Actively interviewing --- 50-80 combined in the differentcountries
4 PhD students (Sweden, Italy, 2 in NL) with cross mentoring
Three face to face meetings
Monthly conference calls
Ethics approval in all the countries
Website for group work
Training in qualitative methods (Atlas course next week) Methods guide
Developed interview tools for patients, providers
Completed comprehensive literature review
Actively interviewing --- 50-80 combined in the differentcountries
4 PhD students (Sweden, Italy, 2 in NL) with cross mentoring
8/3/2019 Improving Fandover Process
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ChallengesChallenges
Linguistic challenges of the team members Different health care delivery models
Different health care financing models
Different administrative challenges related togovernance
Linguistic challenges of the team members Different health care delivery models
Different health care financing models
Different administrative challenges related togovernance
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Summary of Early WinsSummary of Early Wins
We've grown an incredible international community ofscholarship and camaraderie
Face time early on in the grant fostered growing trustwith multiples direct and indirect communication
channels Agreement on consortium rules with a governing
body made up of the chief investigators addressedpublication rights, shared decision making process
Mentorship of research teams visiting other teamshas helped build collaborative spirit
We've grown an incredible international community ofscholarship and camaraderie
Face time early on in the grant fostered growing trustwith multiples direct and indirect communication
channels Agreement on consortium rules with a governing
body made up of the chief investigators addressedpublication rights, shared decision making process
Mentorship of research teams visiting other teamshas helped build collaborative spirit
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Future workFuture work
While we’ve made remarkable progress,we are still in the early stages of ourresearch
Ultimately, the goal is to identify andimplement interventions that can reduce
the risks associated with transitions incare
While we’ve made remarkable progress,we are still in the early stages of ourresearch
Ultimately, the goal is to identify andimplement interventions that can reduce
the risks associated with transitions incare