Maximising learning opportunities in handover.

Accepted 26 February 2009 Handing over responsibility for patients has always been part of medical practice. Definitions emphasise transfer of responsibility to ensure patient safety and the available literature tends to follow this line (see box 1). Handover is much more than this, however. It is a key event where teams meet, have the opportunity to communicate, support each other and learn. This paper considers different ways of maximising learning opportunities in handover, with particular emphasis on the strengths and challenges of the paediatric environment. Alongside review of the best available evidence, many of the ideas discussed were generated from working with a group of 65 experienced paediatricians with particular experience and interest in medical education as part of the Royal College of Paediatrics and Child Health Paediatric Educators Programme. Formal handover has increased in importance and been embedded in practice with the transition from ‘‘on-calls’’ to ‘‘full-shift’’ rotas in an effort to comply with the European Working Time Directive in the United Kingdom (UK). Departments responsible for acute patient care have had to incorporate two or three handover sessions into every day to ensure patient problems and management plans are appreciated by the incoming medical team. Surveys have been conducted to look at handover practices and to consider how changes, perceived to improve practice, can be implemented. It is widely acknowledged that the primary aim of handover is to ensure effective continuity of care for patients, and a number of guidelines and frameworks have been published to promote this. The focus is mainly on clinical risk management and governance, with emphasis on good communication and prioritisation of clinical issues. With evidence suggesting that the quality of handover is often poor, the development of an understanding of how mistakes in handover can lead to serious failures can jump-start initiatives to improve patient safety. Most of these initiatives have been developed with help from outside medicine using, for example, expertise from space, nuclear, aviation and motor-racing industries. 12 Documentation and reporting formats for handover have also been examined. Van Eaton et al demonstrated that an automated computerised patient data system, designed to support handover, enhanced the quality and continuity of patient care. The World Health Organization is promoting a standardised approach to handover communications using the SBAR (Situation, Background, Assessment and Recommendation) questioning technique, which specifies the type of information that needs to be communicated at handover. There are also examples of locally-designed documentation-based handover tools which have been developed to support patient safety. There is likely to be further expansion in the use of these types of tool and as electronic patient records become further established in the use of electronic handover aids. The potential educational value of handover, however, is barely mentioned in current literature. Two recent studies within emergency departments 17 recommend incorporating handover practices into the departmental education programme although they provide little detail of how this might be achieved.