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Handover quality: double-sided cards could improve recording and exchange of information

After a successful Glasgow pilot study of A6 handover cards, more Scottish services adopt the low-tech system

After a successful Glasgow pilot study of A6 handover cards, more Scottish services adopt the low-tech system

Nurse handovers
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The care of critically ill or injured patients could be improved using handover cards, research suggests.

A team led by the University of Stirling investigated the use of small handover cards by paramedics and emergency department staff to exchange vital clinical information about patients.

A pilot, run as part of a pair of studies by the university, found use of double-sided A6 cards led to improvements in data recording, information exchange and overall handover quality.

As a result, the Scottish Ambulance Service and trauma networks in Scotland have adopted the system.

Poor communication

University of Stirling senior lecturer in health sciences David Fitzpatrick, lead author of the two studies, said: ‘Poor communication during patient handover is recognised in international literature as one of the root causes of a significant proportion of preventable deaths. However, little was known about either pre-hospital or emergency department handover processes in Scotland.’

Dr Fiztpatrick's team initially surveyed ambulance staff from across Scotland with various roles – from road-based to rescue helicopter.

Survey findings

A total of 190 responses were received with almost half of the ambulance staff (48%) reporting difficulties in finding the time to prepare for handover to hospital clinicians.

Although more than two thirds (68%) of respondents felt handovers were effective or very effective, concerns were raised about the different mnemonics – acronyms conveying clinical information – used during the process. 

Many crew reported passing information from memory, with interruptions perceived as the biggest barrier to ensuring the right information was received.

Tangible improvements

The team's second study by the team considered the use of the A6-sized cards, which included fields for vital clinical information using one set of mnemonics across the board.

Following a pilot run in Glasgow between February and April 2017, the cards were found to improve the data recording and information exchange of ambulance staff.

The study found improvements in eight out of 12 variables, including recording oxygen saturation, blood pressure and blood glucose scores.

Dr Fitzpatrick said the findings proved there was an appetite for a low-tech system that required little training to use but helped to improve the handover process.

Welcome for standardised mnemonic approach

RCN professional lead for acute, emergency and critical care Anna Crossley welcomed the idea of a standardised mnemonic approach.

She said: ‘The Defence Medical Services have been using mnemonic approaches to handovers for decades to aid communication. For time-critical patients this is vital as the information relayed is concise and everyone knows what information to expect in an understood order.’

A clinical ‘pause’ is also needed, Ms Crossley said, to ensure an interruption-free handover before the hospital team takes over care.


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