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Communication and Patient Safety: Transfer of information between healthcare personnel in anaesthetic clinics
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Resource type
Text
Abstract [en]

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective.

The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews.

The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV).

The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2016. , 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1186
Keyword [en]
anaesthesiologist, anaesthetic clinic, communication, handover, incident reports, information transfer, interruption, memory, nurse, operating theatre, patient safety, post-anaesthesia care unit, safety attitudes, SBAR
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:hig:diva-21387ISBN: 978-91-554-9489-6 (print)OAI: oai:DiVA.org:hig-21387DiVA: diva2:917388
Public defence
2016-04-20, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2017-01-10Bibliographically approved
List of papers
1. An Observational Study of Postoperative Handover in Anesthetic Clinics: The Content of Verbal Information and Factors Influencing Receiver Memory
Open this publication in new window or tab >>An Observational Study of Postoperative Handover in Anesthetic Clinics: The Content of Verbal Information and Factors Influencing Receiver Memory
2015 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 2, 105-115 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Communication, Handover, Memory, Postanesthesia care unit
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:hig:diva-18918 (URN)10.1016/j.jopan.2014.01.012 (DOI)000351842600002 ()25813296 (PubMedID)2-s2.0-84925354569 (Scopus ID)
Projects
KPA
Available from: 2015-02-04 Created: 2015-02-04 Last updated: 2017-12-05Bibliographically approved
2. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study
Open this publication in new window or tab >>SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study
2014 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1Article in journal (Refereed) Published
Abstract [en]

Objectives: We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

Design: A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

Setting: Anaesthetic clinics at two hospitals in Sweden.

Participants: All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and post anaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

Intervention: Implementation of SBAR in an anaesthetic clinic.

Primary and secondary outcomes: The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

Results: In the intervention group, there were statistically significant improvements in the factors “Between-group communication accuracy” (p=0.039) and “Safety climate” (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

Conclusions: Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

Keyword
Anaesthetic clinic, Communication, Incident reports, Safety attitudes, SBAR
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-16185 (URN)10.1136/bmjopen-2013-004268 (DOI)000337363700043 ()2-s2.0-84892875420 (Scopus ID)
Projects
KPA
Available from: 2014-01-26 Created: 2014-01-26 Last updated: 2017-12-06Bibliographically approved
3. Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: a prospective interventional study of postoperative handovers
Open this publication in new window or tab >>Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: a prospective interventional study of postoperative handovers
Show others...
2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 3, 172-178 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking.

OBJECTIVE: The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover.

DESIGN: A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention.

SETTING: The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012.

PARTICIPANTS: Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital.

INTERVENTION: Implementation of the communication tool SBAR in one hospital.

MAIN OUTCOME MEASURES: The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form.

RESULTS: Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time.

CONCLUSION: Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover.

TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

Keyword
postoperative care, postanaesthesia care, communication, Situation-Background-Assessment-Recommendation, SBAR
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:hig:diva-20602 (URN)10.1097/EJA.0000000000000335 (DOI)000369548100003 ()26760400 (PubMedID)2-s2.0-84957092321 (Scopus ID)
Projects
KPA
Available from: 2015-11-17 Created: 2015-11-17 Last updated: 2017-12-01Bibliographically approved
4. Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses
Open this publication in new window or tab >>Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses
(English)Manuscript (preprint) (Other academic)
Keyword
Anaesthetic clinic, Handover, Postoperative, Qualitative study
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:hig:diva-21394 (URN)
Available from: 2016-02-22 Created: 2016-04-07 Last updated: 2016-04-18Bibliographically approved

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