title: Emergency Care Handover (ECHO study) across care boundaries: the need for joint decision making and consideration of psychosocial history.
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.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Sujan
authors.affiliation: Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Chessum
authors.affiliation: United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Rudd
authors.affiliation: Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: Fitton
authors.affiliation: Hampshire Hospitals NHS Foundation Trust, Winchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Inada-Kim
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Spurgeon
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D003299:Cooperative Behavior; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D015274:Interdepartmental Relations; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000592:standards*
keywords: communications; emergency care systems; management, risk management; prehospital care, communications; risk management
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