Clinical handover of patients arriving by ambulance to a hospital emergency department: a qualitative study.
OBJECTIVE
The aims of this study were to (1) explore the clinical handover processes between ambulance and ED personnel of patients arriving by ambulance at one hospital and (2) identify factors that impact on the information transfer to ascertain strategies for improvement.


METHODS
A focused ethnographic approach was used that included participant observation, conversational interviews and examination of handover tools. Participants included ambulance paramedics, nurses and medical practitioners from an ambulance service and regional hospital located in South East Queensland, Australia. Grounded theory methods of constant comparative data analyses were used to generate categories of findings.


RESULTS
Two types of clinical handover were identified: (1) for non-critical patients and (2) for critical patients. Quality of handover appears to be dependent on the personnel's expectations, prior experience, workload and working relationships. Lack of active listening and access to written information were identified issues.


CONCLUSIONS
Clinical handover between two organisations with different cultures and backgrounds may be improved through shared training programmes involving the use of guidelines, tools such as a whiteboard and a structured communication model such as MIST. Future participatory research to evaluate new handover strategies is recommended.
Research Centre for Clinical and Community Practice Innovation, Griffith University & Gold Coast Hospital, Emergency Department, 108 Nerang St., Southport, 4215 Qld., Australia. nerolie_bost@health.qld.gov.au
Nerolie
N
Bost
Julia
J
Crilly
Elizabeth
E
Patterson
Wendy
W
Chaboyer
D000552:Ambulances / Q000458:organization & administration; D000884:Anthropology, Cultural; D003266:Continuity of Patient Care; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D036301:Qualitative Research; D011793:Queensland; D014218:Triage / Q000458:organization & administration