Sujan, Mark-Alexander, Chessum, Peter, Rudd, Michelle, Fitton, Laurence, Inada-Kim, Matthew, Spurgeon, Peter and Cooke, Matthew (2015) Emergency Care Handover (ECHO study) across care boundaries : the need for joint decision making and consideration of psychosocial history. Emergency Medicine Journal . doi:10.1136/emermed-2013-202977 ISSN 1472-0205.

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Abstract

Background: Inadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations. This paper explores both what is communicated (content) and how this is communicated (verbal behaviours) during different types of handover conversations across care boundaries in emergency care.
Methods: Three types of interorganisational (ambulance service to emergency department (ED) in ‘resuscitation’ and ‘majors’ areas) and interdepartmental handover conversations (referrals to acute medicine) were audio recorded in three National Health Service EDs. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis.

Results: 203 handover conversations were analysed. Handover conversations involving ambulance services were predominantly descriptive (60%–65% of utterances), unidirectional and focused on patient presentation (75%–80%). Referrals entailed more collaborative talk focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%–5% of handover conversation content related to the patient's social and psychological needs.
Conclusions: Handover may entail both descriptive talk aimed at information transfer and collaborative talk aimed at joint decision-making. Standardisation of handover needs to accommodate collaborative aspects and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hospitals -- Emergency services, Physician and patient -- Great Britain, Emergency medicine, Emergency medical personnel , Patients -- Care, Patients -- Psychology
Journal or Publication Title:	Emergency Medicine Journal
Publisher:	BMJ Group
ISSN:	1472-0205
Official Date:	February 2015
Dates:	Date Event February 2015 Published 11 September 2013 Available 15 August 2013 Accepted 25 June 2013 Submitted
DOI:	10.1136/emermed-2013-202977
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	21 December 2015
Date of first compliant Open Access:	21 December 2015
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	10/1007/26

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