![]() ![]() The tool was thus expanded to “iSoBAR”, both a word and a mnemonic, which had resonance in the state’s cyclone-prone north-west. However, after consultation and review, it was decided that the existing SBAR tool should be modified and expanded to better fit the local context. Initially, each data element identified was grouped under one of the four SBAR tool headings. A broad range of clinicians and other personnel across WACHS were consulted, including transport providers and staff of the emergency department, intensive care unit and trauma services at the Royal Perth Hospital.Īgreeing to the minimum dataset was non-contentious. 11, 12Įxtensive discussion with doctors, nurses and allied health staff was used to establish a minimum dataset (a common set of information relevant to all handovers), which could be developed into a handover checklist or form. Existing work practices and schedules were also examined, so that handover tools could be incorporated into ingrained habits and patterns. 9, 10 Potential handover issues and traps were identified by mapping patient journeys from a rural facility to a tertiary hospital. The approach involved clinician consultation 8 and a review of processes using a human factors framework. The brief was to develop a standardised and transferable clinical handover process and checklist. After a review of the themes identified above, we determined to target acutely ill, deteriorating patients who required transfer to a higher level of care. The team consisted of two part-time project managers with extensive nursing and rural experience from WACHS, and the Assistant Director of Clinical Services and a project officer with marketing experience from Royal Perth Hospital. In October 2007, a collaborative team was formed between WACHS and the Royal Perth Hospital. Reduce the number of written clinical handover forms.ĭeveloping a standardised clinical handover checklist and protocol Identify factors that influence miscommunication in clinical handover ĭevelop a standardised clinical handover checklist and protocol and In the WACHS context, effective handover procedures are vital. An analysis of local incident and clinical review reports indicates that up to 70% of adverse events occur because of miscommunication and at points of transition or handover of care. Each year, WACHS manages an average of 325 000 emergency department visits, 380 000 inpatient bed-days, 96 000 hospital discharges and 10 000 transfers to tertiary hospital facilities, of which 7 000 are by either the Royal Flying Doctor Service of Australia or the St John Ambulance service. A high proportion of these are overseas-trained doctors and short-term locum appointments. WACHS employs about 5662 full-time-equivalent staff, including 2310 nurses and 180 salaried and 150 contracted Visiting Medical Officers (VMOs). The vast distances between populations create unique challenges in relation to attraction and retention of health care workers and provision of care locally, wherever possible. ![]() The Western Australian Country Health Service (WACHS) ( Box 1) covers an area of 2.53 million square kilometres, with a widely dispersed population of 454 000 people. Issues pertaining to clinical handover are particularly relevant to Australia’s largest country health system. While this tool showed promise, we wished to ensure clinical input and leadership before trialling it in our health care system. One such tool, the SBAR (situation–background–assessment–recommendation) checklist (developed by Kaiser Permanente in the United States), 6, 7 prompts the user to provide information on each of these four elements at each handover event. 4, 5 A review of the literature identified limited tools for clinical handover and a lack of evidence favouring any particular approach. ![]() The development of clinical handover systems such as standard operating procedures has been shown to reduce system failures. Variable and overlapping formats of written communication. The existence of multiple verbal and written contact points between service providers, each with highly individual and/or profession-dependent processes The failure to effectively communicate a patient’s condition when seeking advice or “bed-hunting” 4 A review of local clinical incidents confirmed that this pattern was particularly evident for acutely ill, deteriorating patients who require transfer to a higher level of care. T he failure of effective communication is a recurring theme in the patient safety literature, 1 - 3 specifically as it relates to clinical handover. Statistics, epidemiology and research design.
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