Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

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Part 3B: Critical Appraisal of Research

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Best Practice Proposal

Based on the critical appraisal of the four articles, a best practice that emerges is the implementation of standardized structured handover protocols in healthcare settings to improve patient safety and communication. This practice is supported by evidence across all reviewed studies, demonstrating consistent benefits in reducing errors and enhancing care continuity.

The systematic review by Bukoh and Siah (2020) provides Level I evidence showing that structured handover interventions significantly improve patient safety outcomes. The pilot study by Nasiri et al. (2021) includes Level II evidence, demonstrating that handover checklists enhance communication effectiveness and team satisfaction in high-stakes environments, such as operating rooms. Toren et al. (2022) present Level II evidence from a national project, demonstrating that the large-scale implementation of structured handoffs reduces patient safety incidents across multiple hospitals, thereby proving the feasibility and effectiveness of this approach. Burgener's (2020) Level III conceptual review emphasizes that effective communication strategies, including structured handovers, are foundational to patient safety and satisfaction.

Standardized handover protocols address communication gaps, reduce errors, and enhance team dynamics, as evidenced by both quantitative and qualitative findings. The scalability demonstrated in the national project supports adoption across diverse healthcare settings. Implementation should include developing handover checklists tailored to specific clinical areas, training staff on structured protocols, monitoring compliance, and regularly evaluating outcomes such as error rates and staff feedback.

This best practice aligns with the Johns Hopkins evidence hierarchy, combining high-level evidence from systematic reviews with practical applications from pilot and national studies. By adopting structured handovers, healthcare organizations can enhance patient safety and operational efficiency while addressing ethical considerations such as patient privacy through structured frameworks.

References

Bukoh, M. X., & Siah, C. J. R. (2020). A systematic review on the structured handover interventions between nurses in improving patient safety outcomes. Journal of Nursing Management, 28(3), 744-755.

Burgener, A. M. (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The Health Care Manager, 39(3), 128-132.

Nasiri, E., Lotfi, M., Mahdavinoor, S. M. M., & Rafiei, M. H. (2021). The impact of a structured handover checklist for intraoperative staff shift changes on effective communication, OR team satisfaction, and patient safety: a pilot study. Patient Safety in Surgery, 15, 1-9.

Toren, O., Lipschuetz, M., Lehmann, A., Regev, G., & Arad, D. (2022). Improving patient safety in general hospitals using structured handoffs: outcomes from a national project. Frontiers in Public Health, 10, 777678.