Dr Hamish Dunn Dr Joanna Dargan Dr Lucy Cho
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Transcript of Dr Hamish Dunn Dr Joanna Dargan Dr Lucy Cho
Junior Doctor Perceptions of
Clinical Handover the impact of efficiency, education and
senior clinician facilitation
Dr Hamish DunnDr 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
Themes1. 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
Themes3. 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
clinicians1. Senior Clinicians’ handover input, feedback
and teaching are highly valued by JMOs2. 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
clinicians5. Teach a 5-minute ‘clinical pearl’ when possible during
handover 6. Review emergency team calls to critically unwell
patients7. Use the patients at handover as a stimulus to teaching8. Give non-judgemental feedback on the management of
unwell patients9. Management suggestions on common clinical scenarios
will improve patient care, help JMO confidence in clinical management, and reduce JMO anxiety at work
Themes4. 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 plans4. 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