Original Article
An Observational Study of Postoperative Handover in Anesthetic Clinics; The Content of Verbal Information and Factors Influencing Receiver Memory

https://doi.org/10.1016/j.jopan.2014.01.012Get rights and content

Purpose

The aim was to examine the handover process in the postanesthesia care unit, how much the receiver remembered, and what factors influenced memory.

Design

An observational study with a descriptive and correlational design.

Methods

A total of 73 handovers were investigated, and data were collected using observation, audiotape recordings of the handovers, and the patient's anesthetic record.

Finding

Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with receivers' retention of information were structure and handover duration.

Conclusion

Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

Section snippets

Design

A prospective observational study with descriptive and correlational design was used.

Sample and Setting

A convenience sample was used, and all personnel working at the units taking part in handovers between OR and PACU were invited to participate (N = 83). One sender and three receivers declined to participate during handover. Participants were nurse anesthetists, OR nurses, specialist trainee physicians and anesthesiologists as senders, and intensive care nurses and registered nurses as receivers. At seven

Handover at the PACU

The mean duration of verbal handovers was 2 minutes and 22 seconds (range = 20 seconds to 8 minutes and 44 seconds), and the handover mostly occurred between a nurse anesthetist (n = 59 [81%]) as a sender and intensive care nurse (n = 59 [81%]) as a receiver (Table 1). Interruptions occurred at 56 (77%) handovers. The number of interruptions varied, and these mostly involved signals from monitoring equipment (Table 2). At 13 (18%) handovers, an interruption resulted in a break-in-task of at least 10

Discussion

To our knowledge, this is the first study to analyze factors thought to influence receivers' memory during handover at the PACU. The results of bivariate analyses revealed significant associations between the variable remembered information sequences and the variables structure (the number of information sequences reported during an irregular part of the verbal handover), interruptions, and duration of verbal handover. When analyzed using a multiple regression analysis, the model explains 14.1%

Conclusion

It is important to conduct efficient handovers to ensure patient safety, yet very little research has been done to identify best practice.21 Studying handovers in PACUs, we focused on memory and what factors may influence memory to support future work for strategies to improve handovers. Our study suggests that the lack of structure and long duration of the verbal handover influence information retention among receivers of handovers. Thus, a short verbal handover with a clear structure seems to

Acknowledgments

The authors thank Hans Högberg, Statistician, PhD, University of Gävle, Faculty of Health and Occupational Studies for statistical advice. The authors acknowledge all participants for their willingness to participate in this study.

Maria Randmaa, RN, is a lecturer at the Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; an Intensive Care Nurse at the Department of Anaesthesia, County Council of Gävleborg, Sweden; and a PhD student at the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

References (35)

  • S.Y. Li et al.

    A systematic review of the psychological literature on interruption and its patient safety implications

    J Am Med Inform Assoc

    (2012)
  • L.A. Riesenberg et al.

    Residents' and attending physicians' handoffs: A systematic review of the literature

    Acad Med

    (2009)
  • L.A. Riesenberg et al.

    Nursing handoffs: A systematic review of the literature

    Am J Nurs

    (2010)
  • N. Segall et al.

    Can we make postoperative patient handovers safer? A systematic review of the literature

    Anesth Analg

    (2012)
  • K. Catchpole et al.

    Patient handovers within the hospital: Translating knowledge from motor racing to healthcare

    Qual Saf Health Care

    (2010)
  • L. Lingard et al.

    Communication failures in the operating room: An observational classification of recurrent types and effects

    Qual Saf Health Care

    (2004)
  • K. Nagpal et al.

    Failures in communication and information transfer across the surgical care pathway: Interview study

    BMJ Qual Saf

    (2012)
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    Maria Randmaa, RN, is a lecturer at the Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; an Intensive Care Nurse at the Department of Anaesthesia, County Council of Gävleborg, Sweden; and a PhD student at the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Gunilla Mårtensson, PhD, RN, is a senior lecturer at the Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; and researcher at the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Maria Engström, PhD, RN, is a senior lecturer at the Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; and a researcher and Associate Professor at the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Christine Leo Swenne, PhD, RN, is a clinical senior lecturer at the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Funding: This work was supported by the Faculty of Health and Occupational Studies, University of Gävle and it was also supported by the County Council Gävleborg. It was also supported by the Patient Insurance LÖF (Landstingens Ömsesidiga Försäkringsbolag) and the Swedish Society of Nursing (Svensk Sjuksköterskeförening), but these organizations had no role in the design and running of the study.

    Conflict of interest: None to report.

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