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Cognition, Technology & Work

, Volume 21, Issue 1, pp 133–143 | Cite as

Inter-department patient handoff quality and its contributing factors in Chinese hospitals

  • Xiuzhu GuEmail author
  • Hu-chen Liu
  • Kenji Itoh
Original Article
  • 85 Downloads

Abstract

The aims of the current study were to obtain factors contributing to inter-department patient handoff quality and to uncover characteristics of the current handoffs from the point of view of Chinese healthcare staff. A questionnaire was developed to obtain the staff’s views on inter-department handoffs. An online questionnaire survey was conducted between December 2016 and March 2017. A total of 490 valid responses were collected from physicians, nurses, and assistant nurses. Five handoff factors were derived by applying principal component analysis with 44% of cumulative variance accounted for. Significant differences were observed across three professional groups and assistant nurses had the most negative evaluations. However, a similar trend of views was shared, i.e., they showed a good understanding of their own roles and adequate communication during handoffs. In contrast, it was observed that patient care responsibility and information were sometimes discontinued. From the point of view of staff, the overall handoff quality was mainly affected by mutual communication, the handoff system and environment. The inadequacy of information transfer frequency was reported to be higher when receiving patients than when sending patients, particularly when receiving patients from the emergency or outpatient departments. Generally, healthcare staff in China had a high estimation of the overall quality and safety of inter-department patient handoffs. However, it was observed that information and responsibility were sometimes transferred inadequately. To resolve this discontinuity, we suggest a standardized handoff process, effective use of unlicensed staff and fostering a culture of error reporting and learning.

Keywords

Patient handoff Communication Patient safety Insufficient information 

Notes

Acknowledgements

This work was in part supported by Grant-in-Aid for Young Scientists (B) (No. 15K16291), Japan Society for the Promotion of Science. The authors thank Lifang Chen, RN, No.3 People’s Hospital of Chengdu, China, for her insightful discussions and comments. The authors also thank to the risk management personnel, physicians and nurses who participated in interviews and discussions for providing us with variable information about patient handoffs.

Funding

This study was funded by Grant-in-Aid for Young Scientists (B) (No. 15K16291), Japan Society for the Promotion of Science.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from respondents as described in “Survey sample” section.

References

  1. Andersen HB, Siemsen IMD, Petersen LF, Nielsen J, Ostergaard D (2015) Development and validation of a taxonomy of adverse handover events in hospital settings. Cogn Technol Work 17:79–87.  https://doi.org/10.1007/s10111-014-0303-1 CrossRefGoogle Scholar
  2. British Medical Association (2005) Safe handover: Safe patients. Guidance on clinical handover for clinicians and managers. https://www.bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Contracts/safe%20handover%20safe%20patients.pdf. Accessed 20 Apr 2018
  3. Ekstedt M, Odegard S (2015) Exploring gaps in cancer care using a systems safety perspective. Cogn Technol Work 17:5–13.  https://doi.org/10.1007/s10111-014-0311-1 CrossRefGoogle Scholar
  4. Gleicher Y, Mosko JD, McGhee I (2017) Improving cardiac operating room to intensive care unit handover using a standardised handover process. BMJ Open Qual 6:e000076.  https://doi.org/10.1136/bmjoq-2017-000076 CrossRefGoogle Scholar
  5. Gonzalo JD, Yang JJ, Stuckey HL, Fischer CM, Sanchez LD, Herzig SJ (2014) Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 26:337–347.  https://doi.org/10.1093/intqhc/mzu040 CrossRefGoogle Scholar
  6. Gu X, Itoh K (2011) A pilot study on safety climate in Chinese hospital. J Patient Saf 7:204–212.  https://doi.org/10.1097/PTS.0b013e3182388d0d CrossRefGoogle Scholar
  7. Gu X, Andersen HB, Madsen MD, Itoh K, Siemsen IM (2012) Nurses’ views of patient handoffs in Japanese hospitals. J Nurs Care Qual 27:372–380.  https://doi.org/10.1097/NCQ.0b013e3182573736 CrossRefGoogle Scholar
  8. Gu X, Seki T, Itoh T (2017a) Developing an error taxonomy system for patient handoff events. Proceedings of The IEEE International Conference on Industrial Engineering and Engineering Management-IEEM 2017, Singapore, December 2017Google Scholar
  9. Gu X, Liu H, Itoh K (2017b) Patient handoff quality and safety in China: Health care providers’ views. Proceedings of European Safety and Reliability Conference—ESREL 2017, Portoroz, Slovenia, June 2017. In: Cepin, Briš (eds.) Safety and reliability—theory and applications. Taylor & Francis Group, London, pp 1675–1682Google Scholar
  10. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL (2006) Multivariate data analysis. 6th edn. Pearson Prentice Hall, Upper Saddle RiverGoogle Scholar
  11. Holly C, Poletick EB (2014) A systematic review on the transfer of information during nurse transitions in care. J Clin Nurs 23:2387–2395.  https://doi.org/10.1111/jocn.12365 CrossRefGoogle Scholar
  12. Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY (2009) Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med 53:701–710.  https://doi.org/10.1016/j.annemergmed.2008.05.007 CrossRefGoogle Scholar
  13. Johnson M, Sanchez P, Zheng C (2016) The impact of an integrated nursing handover system on nurses’ satisfaction and work practices. J Clin Nurs 25:257–268.  https://doi.org/10.1111/jocn.13080 CrossRefGoogle Scholar
  14. Kruger J, Dunning D (1999) Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Personal Soc Psychol 77:1121–1134CrossRefGoogle Scholar
  15. Lawrence S, Spencer LM, Sinnott M, Eley R (2015) It takes two to tango: improving patient referrals from the emergency department to inpatient clinicians. Ochsner J 15:149–153Google Scholar
  16. Lee SH, Phan PH, Dorman T, Weaver SJ, Pronovost PJ (2016) Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. BMC Health Services Res 16:254.  https://doi.org/10.1186/s12913-016-1502-7 CrossRefGoogle Scholar
  17. Manser T (2013) Fragmentation of patient safety research: a critical reflection of current human factors approaches to patient handover. J Public Health Res 2:e33.  https://doi.org/10.4081/jphr.2013.e33 CrossRefGoogle Scholar
  18. Manser T, Foster S, Flin R, Patey R (2013) Team communication during patient handover from the operating room: more than facts and figures. Hum Factors 55:138–156.  https://doi.org/10.1177/0018720812451594 CrossRefGoogle Scholar
  19. McElroy LM, Macapagal KR, Collins KM, Abecassis MM, Holl JL, Ladner DP, Gordon EJ (2015) Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study. Am J Surg 210:629–635.  https://doi.org/10.1016/j.amjsurg.2015.05.008 CrossRefGoogle Scholar
  20. Nie Y, Mao X, Cui H, He S, Li J, Zhang M (2013) Hospital survey on patient safety culture in China. BMC Health Services Res 13:228.  https://doi.org/10.1186/1472-6963-13-228 CrossRefGoogle Scholar
  21. Nunnally JC (1978) Psychometric theory. 2nd edn. McGraw-Hill, New YorkGoogle Scholar
  22. Organization for Economic Cooperation and Development (2017) Health at a glance 2017: OECD indicators. https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#page1. Accessed 20 Apr 2018
  23. Parush A, Kramer C, Foster-Hunt T, McMullan A, Momtahan K (2014) Exploring similarities and differences in teamwork across diverse healthcare contexts using communication analysis. Cogn Technol Work 16:47–57.  https://doi.org/10.1007/s10111-012-0242-7 CrossRefGoogle Scholar
  24. Rayo MF, Mount-Campbell AF, O’Brien JM, White SE, Butz A, Evans K, Patterson ES (2014) Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners. BMJ Qual Saf 23:483–489.  https://doi.org/10.1136/bmjqs-2013-002341 CrossRefGoogle Scholar
  25. Reine E, Raeder J, Manser T, Smastuen MC, Rustoen T (2018) Quality in postoperative patient handover: different perceptions of quality between transferring and receiving nurses. J Nurs Care Qual  https://doi.org/10.1097/NCQ.0000000000000318 Google Scholar
  26. Richter JP, McAlearney AS, Pennell ML (2016) The influence of organizational factors on patient safety: examining successful handoffs in health care. Health Care Manag Rev 41:32–41.  https://doi.org/10.1097/HMR.0000000000000033 CrossRefGoogle Scholar
  27. Riesenberg LA et al (2009) Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med 84:1775–1787.  https://doi.org/10.1097/ACM.0b013e3181bf51a6 CrossRefGoogle Scholar
  28. Riesenberg LA, Leitzsch J, Cunningham JM (2010) Nursing handoffs: a systematic review of the literature. Am J Nurs 110:24–34.  https://doi.org/10.1097/01.NAJ.0000370154.79857.09 (quiz 35–26) CrossRefGoogle Scholar
  29. Robertson ER, Morgan L, Bird S, Catchpole K, McCulloch P (2014) Interventions employed to improve intrahospital handover: a systematic review. BMJ Qual Saf 23:600–607.  https://doi.org/10.1136/bmjqs-2013-002309 CrossRefGoogle Scholar
  30. Sansosti LE, Crowell A, Ellis-McConnell W, Meyr AJ (2018) A survey of patient care handoff and sign-out practices among podiatric surgical residency programs. J Am Podiatr Med Assoc 108:151–157.  https://doi.org/10.7547/16-094 CrossRefGoogle Scholar
  31. Stelfox HT et al (2017) A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward. Intensive Care Med 43:1485–1494.  https://doi.org/10.1007/s00134-017-4910-1 CrossRefGoogle Scholar
  32. van Sluisveld N, Hesselink G, van der Hoeven JG, Westert G, Wollersheim H, Zegers M (2015) Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Intensive Care Med 41:589–604.  https://doi.org/10.1007/s00134-015-3666-8 CrossRefGoogle Scholar
  33. Wears RL (2015) Standardisation and its discontents. Cogn Technol Work 17:89–94.  https://doi.org/10.1007/s10111-014-0299-6 CrossRefGoogle Scholar
  34. WHO Patient Safety Alliance (2007) Communication during patient hand-overs: Patient safety solutions, volume 1, solution 3. http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf. Assessed 20 Apr 2018
  35. Zhou P, Li M, Wei X, Zhu H, Xue D (2017) Patient safety climate in general public hospitals in China: a multiregion study. J Patient Saf  https://doi.org/10.1097/PTS.0000000000000427 Google Scholar
  36. Zhu J, Li L, Zhou Z, Lou Q, Wu AW (2016) Variations in patient safety climate in Chinese hospitals. J Patient Saf  https://doi.org/10.1097/PTS.0000000000000319 Google Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Industrial Engineering and Economics, School of EngineeringTokyo Institute of TechnologyTokyoJapan
  2. 2.Department of ManagementShanghai UniversityShanghaiChina

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