homework
[Nursing Reports 2019; 9:8041] [page 1]
A quantitative study on personnel’s experiences with patient handovers between the operating room and the postoperative anesthesia care unit before and after the implementation of a structured communication tool Ann-Chatrin Leonardsen, Ellen Klavestad Moen, Gro Karlsøen, Trine Hovland Østfold Hospital Trust, Norway
Abstract Postoperative handover of patients has
been described as a complex work process challenged by interruptions, time pressure and a lack of supporting framework. The purpose of this study was to investigate involved personnel’s experiences with the quality of patient handovers between the operating room and the postoperative anes- thesia care unit (PACU) before and after implementation of a structured tool for communication. The study was conducted in a hospital in South-eastern Norway. Personnel completed a questionnaire before (n=116) and after (n=90) implementation of the Identification-Situation-Assessment- Recommendations (ISBAR)- tool. Analysis included summative statistics, t-tests and generalized linear regression analysis. Statistical significance assumed at P<0.05.
The overall impression of quality in handovers improved significantly after implementation of the ISBAR (P=0.001). Personnel’s experiences were improved in relation to that handovers followed a logical structure, available documentation was used and all relevant information was com- municated (P<0.001). Moreover, personnel found it easier to establish contact at the beginning of the handover, ambiguities were resolved and documentation was more complete (P=0.001). Profession was associ- ated with seven of the statements, relating to whether relevant information is clearly communicated, whether possible risks and complications are discussed, contact easily established, and to completeness of docu- mentation and information. In addition, findings indicate significantly more nega- tive experiences among receiving personnel both pre- and post-implementation.
Implementation of a structured tool for communication in patient handovers, may
improve quality and safety in patient han- dovers between the operating room and the PACU. Research is needed to define opti- mal patient handovers and to determine the effect of handover quality on patient out- comes.
Introduction The risks associated with perioperative
care and anesthesia do not end when the patient leaves the operating room- the potential for complications continues dur- ing the patient transfer to the postoperative anesthesia care unit (PACU).1 In the PACU, patient care is transferred from the Nurse Anesthetist (NA)/Anesthesiologist/Surgical Nurse (SN) to a PACU Registered Nurse (RN) or Critical Care Nurse (CCN). The handover is usually completed at the patient’s bedside, with the NA/SN verbally reporting to the RN/CCN. The handover includes the exchange of essential medical information, which occurs throughout all phases of care, and is at risk of degradation and miscommunication.2 During the recov- ery period, the patient is at risk of potential complications after surgery or anesthesia. Furthermore, patients are often subject to a downscale in monitoring and observation, which makes them vulnerable to incidents and errors.1,3,4 Postoperative handover of patients have been described as a complex work process challenged by interruptions, time pressure and a lack of supporting framework.3
According to the Joint Commission approximately 80% of medical errors are due to communication failure during the patient transfer process.5 Nagpal et al.6 found that only 55.8% of all relevant infor- mation is transferred from the operating room to the PACU. Moreover, studies have shown that the verbal information transfer are unstructured, and that important infor- mation is omitted.7,8 Poor communication and incomplete transfer of information may threaten patient safety, and may lead to unplanned readmissions and adverse events.9,10
Studies suggest that the use of a check- list during handovers could help providers correctly exchange information and increase the adequacy for nurse receivers.1 The Situation, Background, Assessment and Recommendation (SBAR) tool has become the Joint Commission’s suggested best practice for standardized communication in healthcare, structuring critical verbal infor- mation, and is also recommended by the World Health Organization (WHO).11 The Identification-Situation-Background- Assessment-Recommendation (ISBAR) – a
variant of the SBAR – is utilized in hospi- tals, e.g. in Denmark and Australia.12-14
Recent studies have mainly been con- ducted on handovers between e.g. ambu- lance personnel and the emergency depart- ment, from specialist- to primary healthcare services or between in-hospital personnel shifts.15,16 A systematic review of the litera- ture found 31 studies examining postopera- tive handoffs.4 Of these, only four studies included an intervention to improve the process.
Aims The study was grounded in feedback
from PACU nurses that the quality of patient handovers needed improvement, especially related to transfer of sufficient and critical information. Consequently, the study aims were: i) to investigate the per- sonnel’s experiences with the quality of patient handovers between the operating room and the PACU before and after imple- mentation of a tool aiming at improving communication during patient handovers (the ISBAR); ii) to investigate whether there were different experiences with patient handover quality among transferring and receiving personnel; iii) to investigate whether factors such as gender, age, profes- sional background and years of experience were associated with these experiences.
Nursing Reports 2019; volume 9:8041
Correspondence: Ann-Chatrin Leonardsen, Østfold Hospital Trust, Kalnesveien 300, 1714 Grålum, Norway. E-mail: ann.c.leonardsen@hiof.no
Key words: Personnel’s experiences; patient handovers; postoperative anesthesia care unit; quantitative study.
Contributions: all authors contributed in plan- ning of the study, data collection, analysis and writing.
Conflict of interest: the authors declare no potential conflict of interest.
Funding: funding was granted by collabora- tion funds from Østfold Hospital Trust/Østfold University College.
Received for publication: 18 January 2019. Revision received: 12 March 2019. Accepted for publication: 13 March 2019.
This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).
©Copyright A-C. Leonardsen et al., 2019 Licensee PAGEPress, Italy Nursing Reports 2019; 9:8041 doi:10.4081/nursrep.2019.8041
No n-c
om me
rci al
us e o
nly
[page 2] [Nursing Reports 2019; 9:8041]
Materials and Methods The study had a cross-sectional, quanti-
tative design, with two points of measure- ment, using a questionnaire to investigate personnel’s experiences with patient han- dovers.
Setting and participants The study was conducted in a hospital
in a county in South-eastern part of Norway, which has a catchment area of approximate- ly 290,000 inhabitants. The surgical ward in the hospital conducts about 8000 acute or elective surgical interventions each year, distributed on different specialties; gas- troenterology, gynaecology, endocrinology, mammae surgery, urology, orthopedics, ear/nose/throat- and vascular surgery, as well as trauma surgery. The PACU is locat- ed in immediate proximity to the operating room.
A consecutive sampling method was used: All the NAs, anesthesiologists, SNs, RNs and CCNs involved in patient han- dovers were invited to participate in a ques- tionnaire study before and after implemen- tation of the ISBAR tool. Table 1 gives an overview of respondents’ professional background, age and years of experience pre- and post-implementation (Table 1). There were significant differences in gender pre- and post implementation, with 75.7% female pre-, and 87.4% post-implementa- tion (P<0.001). Only one anesthesiologist responded to the questionnaire (pre-inter- vention), and has been excluded from the analysis.
Procedure The operating room and PACU person-
nel were informed about the study aims and procedures during professional meetings. In addition, all personnel received email infor- mation, and information was included in weekly newsletters sent out by leaders in the respective wards.
Questionnaires were printed out in paper and delivered to all personnel directly involved in patient handovers. Completed questionnaires were returned in a sealed box in a room at each ward, and collected by researchers once a week. Reminders to complete the questionnaire were sent out twice by email, to all of the invited person- nel, before end of data collection.
The pre-implementation questionnaire study was conducted over three weeks, in January 2017. The questionnaire study was repeated six months after implementation, in November 2017.
Implementation The implementation of the ISBAR tool
was conducted in three phases.
Development and local adjustment
The ISBAR tool was based on the trans- lated version implemented in Rikshospitalet, Oslo University Hospital, and locally adapted by the research group, which consisted of one NA, one SN, one CCN as well as the project leader/first author, also NA. Before implementation, the ISBAR was sent out to five NAs, five SNs and five CCNs respectively, to test the face- and content validity of the tool, assessing the adequacy, appropriateness and understandability of the tool as well as lan- guage and usage instructions.17 This revealed no problematic issues in any of these aspects.
Education of involved personnel
Coursing was conducted by members of the research group during personnel meet- ings, as well as through information distrib- uted by email.
Implementation (April 2017)
This included information to leaders as well as surgeons which could possibly be affected by the process, due to a potentially longer handover time. Moreover, a resource group with CCNs was established, taking part in patient handovers the two first weeks of the implementation, in addition to mem- bers from the research group.
The questionnaire A handover quality rating form (HQRF)
developed by Manser et al.,18,19 and translat- ed to Norwegian by Reine et al.20 (the N- HQRF) was used. The questionnaire includes three factors predicting handover quality: information transfer, shared under- standing and working atmosphere. The N- HQRF consists of 19 statements. Response alternatives are agree, partly agree, partly disagree and disagree. Since the question- naire was adjusted to our purpose, we chose to conduct a repeated test of face- and con- tent validity as described with the ISBAR (piloted to 5 NAs, 5 SNs, 5 CCNs), reveal- ing no problematic issues related to adequa- cy, appropriateness and understandability of the tool, as well as language.
The questionnaire also included infor- mation about professional background, years of experience from the current ward (0-2, 3-5, 6-9, 10 or more), gender and age.
The post-intervention questionnaire also included a question whether ISBAR was used in patient handovers, and whether the respondent perceived that using the
ISBAR has led to safer and higher quality patient handover.
Internal consistency of the N-HQRF was assessed by Cronbach’s alpha=0.7, which is assumed acceptable.21
Analysis Data was analyzed using the Statistical
Package for the Social Sciences (SPSS) ver- sion 24 (IBM Corporation, IBM SPSS Statistics for Windows, Version 21.0. New York, Armonk, 2012).
Answers were dichotomized into either positive or negative experiences: Agree and partly agree were collated, as well as dis- agree and partly disagree. Summative statistics were used to present characteris- tics of the sample. T-tests were used to pre- sent differences pre- and post-implementa- tion and between personnel. A generalized linear regression model using profession, age, gender and years of experience as inde- pendent variables, and each statement as dependent variables was used to detect fac- tors associated with experiences. Significance was assumed at P<0.05.
Ethical considerations The Regional Committee for Medical
and Health Research Ethics in Norway judged the study as quality improvement (ref. no. 2016/2104A). Approval was sought and received from the Norwegian Social Sciences Data Services (ref. no. 51479).
The study was based on the principles in the declaration of Helsinki,22 on voluntary participation, anonymity, and confidentiali- ty. It is not possible to recognize any of the respondents in the study results. Consent was assumed when respondents completed and returned the questionnaire.
Results As described in Table 1, there were no
significant differences between the transfer- ring and receiving ward in the pre- and post- implementation study regarding age or years of experience.
Comparison of pre- and post-inter- vention responses
Significant differences on the question- naire statements pre- and post- implementa- tion of the ISBAR are presented in Table 2.
Table 2 shows that the overall impres- sion of quality in handovers improved sig- nificantly (P=0.001). Personnel’s experi- ences were improved in relation to that han- dovers followed a logical structure, avail- able documentation was used and all rele- vant information was communicated
Article
No n-c
om me
rci al
us e o
nly
[Nursing Reports 2019; 9:8041] [page 3]
(P<0.001). Moreover, personnel found it easier to establish contact at the beginning of the handover, ambiguities were resolved and documentation was more complete (P=0.001).
Differences between personnel pre- and post-implementation
Table 3 gives an overview of significant differences between transferring and receiv- ing nurses pre- and post-implementation (Table 3).
Table 3 shows that receiving nurses had significantly more negative experiences on six of the statements, related to complete- ness of information and utilization of avail- able documentation. Transferring nurses experienced to a larger extent that it was difficult to establish contact at the begin- ning of handovers.
Experiences with the ISBAR tool Approximately 91% of transferring per-
sonnel claimed to be using the ISBAR in patient handovers, and this was supported by 96.7% of receiving personnel stating that the transferring personnel used the ISBAR. The effect of using the ISBAR was indicat-
ed through that 92.1% stated that ISBAR had led to a better and safer patient han- dover. Nevertheless, 13.6% claimed that ISBAR did not have any effect on patient safety or quality in patient handovers.
Factors impacting the experiences Few significant associations were iden-
tified. The statement The person handling over the patient is under time pressure was negatively associated with years of experi- ence (P=0.008).
Profession was associated with seven of the statements; namely All relevant infor- mation is selected and communicated (Beta=0.06 (Standard Error (SE)=0.03), R2=0.07, P=0.02), The person handling over the patient communicate her/his assessment of the patient clearly (Beta=0.09 (SE=0.03), R2=0.08, P=0.04), Possible risks and complications are dis- cussed (Beta=0.12 (SE=0.03), R2=0.09, P<0.001), It is easy to establish good con- tact at the beginning of a handover (Beta=-
Article
Table 1. Respondents’ professional background, age and years of experience pre- and post- implementation.
Pre (n=116) Post (n=90) P-value
Transferring NA 62.5 25 0.65 SN 42.4 45 Receiving CCN/RN 63.6 50.5 Age (mean) 48.0 47.4 0.94 Experience (years) 0-2 14.7 0-2 10 0.73 3-9 31 3-9 34.4 10+ 53.4 10+ 55.6 NA, nurse anesthetist; SN, surgical nurse; CCN, critical care nurse. RN, registered nurse. Proportion of the population in percentage. Transferring: transferring ward – the operating personnel room. Receiving: receiving ward – the postoperative anesthesia care unit personnel. Experience: respondents’ work experience from current ward, in years, reported in percent. Significance level, P<0.05. Independent samples t-test, equal variances assumed.
Table 2. Significant differences pre- and post- implementation.
Statement Pre (n=116) Post (n=90) P-value Often/Agree Seldom/Disagree Often/Agree Seldom/Disagree
The person taking over the responsibility is under time pressure 69.7 30.3 60.5 39.5 0.01 The handover followed a logical structure 81.2 18.8 97.8 2.2 <0.001 The person handling over the patient continuously used available 47 57.3 85.7 14.3 <0.001 documentation to structure the handover All relevant information is selected and communicated 87.6 12.4 97.8 2.2 <0.001 It is easy to establish good contact at the beginning of a handover 81.2 18.8 89.1 10.9 0.001 Questions and ambiguities are resolved 87.8 12.2 95.6 4.4 <0.001 The team jointly assure that the handover is complete 53.8 46.2 73.3 26.7 <0.001 Documentation is complete 73.3 26.7 91 9 <0.001 The patients’ experience is considered carefully during handover 69 31 77.3 22.7 0.007 Overall, the quality of the handovers is very high 82.6 17.4 93.3 6.7 <0.001 Proportion of responses in percent. Significance level, P<0.05. Independent samples t-test, equal variances assumed.
Table 3. Significant differences between transferring and receiving personnel pre- and post implementation.
Pre Post Statement Transferring Receiving P-value Transferring Receiving P-value
Available documentation used for structure 2.4 (0.09) 2.7 (0.08) 0.01 - - - Relevant information communicated 1.8 (0.07) 2.1 (0.06) <0.01 1.8 (0.06) 2.0 (0.05) 0.04 Possible risks discussed 2.2 (0.09) 2.6 (0.07) <0.01 2.2 (0.08) 2.6 (0.08) <0.001 Easy to establish contact 2.3 (0.08) 2.1 (0.03) 0.03 2.1 (0.1) 1.9 (0.06) 0.04 Documentation complete 1.8 (.07) 2.5 (0.06) <0.01 1.9 (0.07) 2.1 (0.05) 0.001 Too much information 2.9 (0.07) 3.2 (0.06) <0.01 - - - Overall, the quality of the handovers is very high 2.0 (0.07) 2.2 (0.06) 0.03 - - - Attempts are made to minimize interruptions - - - 2.5 (0.1) 2.2 (0.06) 0.03 Responses in mean, standard error in parenthesis. 1=always, 2=often, 3=seldom, 4=never. Significance level, P<0.05. Independent samples t-test, equal variances assumed.
No n-c
om me
rci al
us e o
nly
[page 4] [Nursing Reports 2019; 9:8041]
0.05 (SE=0.02), R2=0.05, P=0.045), Documentation is complete (Beta=0.12 (SE=0.03), R2=0.09, P<0.001), There is too much information given (Beta=0.09 (SE=0.03), R2=0.08, P=0.001), and Too much information is asked for (Beta=0.09 (SE=0.03), R2=0.07, P=0.001).
Discussion Results indicate that implementation of
the ISBAR tool in handovers of patients between the operating room and the PACU improve quality and safety. Personnel’s experiences were improved in relation to that handovers followed a logical structure, available documentation was used and all relevant information was communicated after implementation of the ISBAR tool. Moreover, personnel found it easier to establish contact at the beginning of the handover, ambiguities were resolved and documentation was more complete. Receiving personnel reported of more neg- ative experiences with patient handovers than transferring personnel.
Results indicate that both transferring and receiving personnel had more positive experiences with patient handovers after implementation of the ISBAR tool. The experience of overall patient handover qual- ity increased from 82.6% to 93.3%. Handovers followed a more logical struc- ture, available documentation was used and all relevant information was communicated after implementation of the ISBAR tool. This is in line with earlier studies, showing that standardized handover tools result in better flow of information, a reduction in omission of relevant information and an increase in involved personnel satisfac- tion.3,6,20,23 In addition, studies have shown a decrease in number of defects per handoff.23 This aspect was not approached in the cur- rent study.
Moreover, personnel found it easier to establish contact at the beginning of the handover, ambiguities were resolved and documentation was more complete. This has also been suggested in studies indicat- ing that structured communication tools have a positive effect on teamwork.3,6
Initiating a project focusing on improv- ing patient handover may have led to an increased emphasis among personnel. In addition, the study was grounded on input from receiving personnel that improvement was needed. Nevertheless, e.g. Cornell et al.24 found that using SBAR helped nurses to be more focused and spend less time dur- ing handovers. However, Petrovic et al.23 found that the mean duration of handoffs increased by 2 minutes (P<0.01).23 We did
not include information about the time aspect in the current study.
Post-implementation findings may have been affected by other factors, due to the implementation itself. Implementation sci- ence literature suggests that there are many factors that can impede implementation of a new program, e.g., resources, leadership support or communication.25,26 During implementation, more personnel were pres- ent in the PACU ward, posters with infor- mation were placed in the ward, leaders supported the implementation (and ice- cream was served at the end of the two first weeks). A study on implementation chal- lenges showed that communicating with team members and other areas in the organ- ization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources are factors that decrease imple- mentation challenges.27
Moreover, results show that receiving personnel had more negative experiences regarding safety and quality of patient han- dovers. This was related to if available doc- umentation was used and complete, if rele- vant information was communicated, and possible risks discussed. This relation is also identified in the analysis of factors associated with personnel’s experiences, since profession was significantly associat- ed with seven of the statements. This is in line with studies showing that transferring and receiving nurses have different expecta- tions concerning content and timing of information, and that transferring nurses have more positive evaluations of handover quality compared with the receiving nurses.7,20,28 Moreover, differences has been found between health professions in terms of how effectively they hand over the patient, and on the awareness of severity of adverse events relating to poor handovers.28 The explanation to this may be that receiv- ing personnel is taking over the responsibil- ity for the patient, and hence have a greater need to have the total overview of the patients’ condition.
Limitations One limitation could be that different
personnel were included in the pre- and post-implementation phases. Nevertheless, few significant differences between the two groups were identified (only gender). The sample sizes pre- and post-implementation were also relatively small, and few were men. The study took place in one hospital only, hence findings may not be generaliz- able to other wards and settings.
Moreover, the post-implementation questionnaire study was conducted only six months after implementation of the ISBAR.
Studies have shown that the use of check- lists in healthcare represents challenges with implementation and compliance,29-31 which has also been shown when imple- menting the ISBAR.32-34 Results could have been different if we had conducted the post- implementation study at a later point.
We did not compare the ISBAR tool with other approaches to improving patient handovers, or focus on patient outcomes such as patient mortality or morbidity. This would be interesting to include in further studies of quality and safety in patient han- dovers between the operating room and the PACU. It is also possible that the positive changes was due to the Hawthorne effect.35
Conclusions Results indicate that implementation of
a structured tool for communication in patient handovers, such as the ISBAR, may improve quality and safety in handovers of patients between the operating room and the PACU. Moreover, this may positively impact personnel’s experiences with differ- ent aspects of the handover, such as team- work. Innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes.
References 1. Robins H, Dai F. Handoffs in the posto- perative anaesthesia care unit: use of a checklist for transfer of care. AANA J 2015;83:264-8.
2. ElBardissi A, Regenbogen S, Greenberg C, et al. Communication practices on 4 Harvard surgical services: a surgical safety collaborative. Ann Surg 2009;250:861-5.
3. Møller T, Madsen M, Fuhrmann L, Østergaard D. Postoperative handover: characteristics and considerations on improvement. A systematic review. Eur J Anaesth 2013;30:229-42.
4. Segall N, Bonifacio A, Schroeder S. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012;115:102-15.
5. Joint Commission. Joint Commission introduces new, customized tool to improve hand-off communictions. 2012. Available from: http://www.joint- commission.org/issues/article.aspx?Art icle=RZlHoUK2oak83WO8RkCmZ9h VSIJT8Zbrl4NznZ1LEUk%3D.
6. Nagpal K, Abboudi M, Manchanda C,
Article
No n-c
om me
rci al
us e o
nly
[Nursing Reports 2019; 9:8041] [page 5]
et al. Improving postoperative hand- over: a prospective observational study. Am J Surg 2013;206:494-501.
7. Smith A, Pope C, Goodwin D, Mort M. Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room. Br J Anaesth 2008;101:332-7.
8. Siddiqui N, Arzola C, Iqbal M, et al. Deficits in information transfer between anaesthesiologists and postanaesthesia staff: an analysis of patient handover. Eur J Anaesthesiol 2012;29:438.
9. Naylor M. Nursing intervention rese- arch and quality of care: influencing the future of healthcare. Nurs Res 2003;52: 380-5.
10. Alper E, O’Malley T, Greenwald J. Hospital discharge and readmission. UpToDate 2017 [Epub ahead of print].
11. World Health Organization (WHO). Human factors in patient safety. Review of topics and tools. Report for methods and measures working group of WHO patient safety. WHO: Geneva, Switzerland; 2009. Available from: https://www.google.com/url?sa=t&rct= j&q=&esrc=s&source=web&cd=1&ve d=2ahUKEwiI_7PPxs3iAhUowqYKH dTzCtwQFjAAegQIAxAC&url=https %3A%2F%2Fwww.who.int%2Fpatient safety%2Fresearch%2Fmethods_mea- sures%2Fhuman_factors%2Fhuman_fa ctors_review.pdf&usg=AOvVaw3Q_Z MIKGNnTY8Dy9EyEQ6N
12. Department of Health and Ageing, Government of South Australia. ISBAR. A standard mnemonic to improve clinical communication. Australia: SA Health; 2011. Available from: https://www.sahealth.sa.gov.au/ wps/wcm/connect/public+content/sa+h ealth+internet/resources/isbar+a+stan- dard+mnemonic+to+improve+clini- cal+communication
13. Andreoli A, Fancott C, Velji K, et al. Using SBAR to communicate falls risk and management in inter-professional rehabilitation teams. Healthc Q 2010;13:94-101.
14. Dansk Selskab for Patientsikkerhed. [Håndbog i sikker mundtlig kommuni- kation]. 2007. Available from:
http://www.patientkommunikation.dk/ media/1078/smk-haandbogen.pdf
15. Wood K, Crouch R, Rowland E, Pope C. Clinical handovers between pre-hos- pital and hospital staff: literature revi- ew. Emerg Med J 2015;32:577-81.
16. Humphries C, Jagnathan S, Penniyammakal J, et al. Investigating clinical handovers and healthcare com- munication for outpatients with chronic disease in India: a mixed-methods study. PLoS One 2018;13:e0207511.
17. Polit D, Beck C. Nursing research prin- ciples and methods. 9th ed. Baltimore: Lippincott Williams & Wilkins; 2012.
18. Manser T, Foster S, Gisin S, et al. Assessing the quality of patient hand- offs at care transitions. Qual Saf Health Care 2010;19:1-5.
19. Manser T, Foster S, Flin R, Patey R. Team communication during patient handover from the operating room: more than facts and figures. Human Factors 2013;55:138-56.
20. Reine E, Manser T, Rustøen T. Quality in postoperative patient handover. J Nurs Care Qual 2019;34:E1-7.
21. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ 2011;2:53-5.
22. World Medical Association. Declaration of Helsinki - Ethical princi- ples for medical research involving human subjects. WMA; 2015. Available from: https://www.wma.net/policies- post/wma-declaration-of-helsinki-ethi- cal-principles-for-medical-research- involving-human-subjects/
23. Petrovic M, Aboumatar H, Scholl A, et al. The perioperative handoff protocol: evaluating impacts on handoffs and pro- vider satisfaction in adult perianesthesia care units. J Clin Anesthesia 2014;27:111-9.
24. Cornell P, Gervis M, Yates L, et al. Improving shif report focus and consi- stency with the situation, background, assessment recommendation protocol. J Nurs Adm 2013;43:422-8.
25. Chaudoir R, Dugan A, Barr C. Measuring factors affecting implemen- tation of health innovations: a systema- tic review of structural, organizational,
provider, patient, and innovation level measures. Implement Sci 2013;8:22.
26. Kadu M, Stolee P. Facilitators and bar- riers of implementing the chronic care model in primary care: a systematic review. BMC Fam Pract 2015;16:12.
27. Sullivan J, Adjognon L, Omonyele L, et al. Identifying and overcoming imple- mentation challenges: experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration. Health Care Manage Rev 2018;43:193-205.
28. Carroll J, Williams M, Gallivan T. The ins and outs of change of shift handoffs between nurses: A communication chal- lenge. BMJ Qual Saf 2012;21:586-03.
29. Manias E, Geddes F, Watson B, et al. Perspectives of clinical handover pro- cesses: a multi-site survey across diffe- rent health professionals. J Clin Nurs 2015;25:80-91.
30. Lyons V, Popejoy L. Time-out and checklists: a survey of rural and urban operating room personnel. J Nurs Care Qual 2017;32:3-10.
31. Pickering S, Robertson E, Griffin D, et al. Compliance and use of the World Health Organization checklist in U.K. operating theatres. Br J Surg 2013;100:1664-70.
32. Rydenfalt C, Johansson G, Odenrick P, et al. Compliance with the WHO Surgical Safet Checklist: deviations and possible improvements. Int J Qual Health Care 2013;25:182-7.
33. Kitney P, Buttigieg D, Bennet P, et al. Handover between anaesthetists and post anaesthetic care unit nursing staff using ISBAR principles. AORN 2016;29:30-7.
34. Yegane S, Shahrami A, Hatamabadi H, Hosseini-Zijoud S-M. Clinical informa- tion transfer between EMS staff and Emergency Medicine Assistants during handover of trauma patients. Prehosp Disaster Med 2017;32:541-7.
35. McCambridge J, Witton J, Elbourne D. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J Clin Epidemiol 2014;67:267-77.
Article
No n-c
om me
rci al
us e o
nly
Copyright of Nursing Reports is the property of PAGEPress and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.