Development of a model to address the content, process and communication aspects of emergency centre handover

Doctoral Thesis


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Introduction: The emergency centre forms the first formal interaction between the prehospital and inhospital phases of the patient care continuum. There are several variables that have the potential to affect handover efficacy. Poor handover has been associated with an increase in sentient events and a risk to patient safety. This thesis aimed to investigate the perceptions of the practice of patient handover between prehospital emergency care providers and the emergency centre. This information was used to generate a model that addresses identified aspects of the emergency centre handover, namely content, process, and communication. Methods: The methodology followed a sequential, explanatory, mixed-methods design. Data were collected from prehospital emergency care personnel (PECP) and emergency centre personnel (ECP) in the Johannesburg area of South Africa. Study One and Study Two formed the quantitative and qualitative data collection phases respectively. Study One formed the quantitative component of the study using a survey that utilised a crosssectional, convenience design. Questionnaires were compiled de novo using data sourced from a search of major databases and were pilot tested prior to distribution. Questionnaires contained a mix of Likert-type, forced binary and open-ended questions. Questionnaires were distributed using a purposive, convenience strategy where potential participants were approached at their place of work. Data were analysed descriptively and reported on. The responses to the open-ended questions were used to compile the interview schedule used in Study Two. Study Two formed the qualitative approach of the thesis and used a qualitative descriptive design. Questions for Study Two were compiled using the results of the coding, analysis and interpretation of the responses to the open-ended questions from the paper-based questionnaire. Data were collected from 15 PECP and 15 ECP using face-to-face, semi structured interviews. Participants were approached using a purposive strategy and, where consent was obtained, were interviewed in a location that was conveniently available and afforded an adequate amount of privacy. Interviews were transcribed and then analysed using Computer-Assisted Qualitative Data Analysis Software Atlas.ti. Data were read and reread, coded and analysed to identify categories and themes that were then reported. A code-recode strategy ensured trustworthiness. Results: Handover content variables were ranked according to the perceived level of importance by prehospital emergency care and ECP. Physiological variables dominated the ten most important variables for both PECP and ECP. Handover quality was perceived by both PECP and ECP as requiring improvement. Less than half of both PECP and ECP had been exposed to formal handover training. Mnemonic knowledge was generally poor, and the most familiar mnemonic used by PECP was unfamiliar to the ECP. The same was true for the mnemonic most familiar to the ECP. Process factors that had the potential to affect the efficacy of emergency centre handover included repetition of information and having to hand over multiple times. The busyness of the emergency centre and the noisy environment associated with it were linked to compromised patient privacy and a distractive environment in which to hand over. Understaffing and overworked staff were identified as barriers to an effective handover process and contributors to some of the identified issues related to poor emergency centre handover. There were several communication factors identified by both PECP and ECP that negatively affected handover efficacy. Verbal, non-verbal and paraverbal cues were identified as having he potential to act as facilitators of or barriers to effective emergency centre handover. Listening skills were identified as a barrier to effective handover by both PECP and ECP. Interprofessional communication and relationships were identified as important for effective emergency centre handover. Using the data, a novel model was developed using an iterative process. The model proposes solutions to some of the content, process and communication problems that were identified in this thesis. The model sees handover as comprising of five phases of information flow and unlike many previous models, recognises the bidirectional nature of communication within the handover process. Conclusion: Emergency centre handover between PECP and ECP needs improvement. The novel model proposed in this thesis divides handover into phases, each of which has identified factors that have the potential to act as facilitators of or barriers to effective handover. The model has potential to be implemented in emergency centre handover environments and may also have relevance in other patient handover environments.