Junior Doctor Perceptions
of Clinical Handover
the impact of efficiency, education and
senior clinician facilitation
Dr Hamish Dunn
Dr Joanna Dargan
Dr Lucy Cho
Background
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Role of poor communication in sentinel events
Increasing international focus
Need for structural and organizational support
WHY JMOs?
– Inexperienced
– Communication quality and content
– Lack of standardised protocols
– Fatigued clinicians
• Paucity of evidence – especially from JMO
perspective
Methods
• Qualitative study
– JMO-led focus groups
– semi-structured individual interviews
• in-depth supplement to the broader concept
evaluation of the NSW Acute Care Taskforce:
JMO Clinical Handover Project
• Thematic analysis
consensus framework
45 JMOs at 6 NSW Hospitals
Themes
1. Efficiency
– “It’s not always safest for us to come off the ward
for handover.” [Intern]
– flexible standardisation
– ISBAR
2. Handover Tools
– “Once it’s on paper you have to do something
about it.” [Intern]
– Documentation not duplication
Themes
3. Education & Supervision
– “relieves that anxiety about your management”
[Intern]
– “Otherwise you get nothing on overtime” [RMO]
– Education and feedback are the “selling points”
[Intern] of the handover process
Handover facilitation guide
for senior clinicians
1. Senior Clinicians’ handover input, feedback
and teaching are highly valued by JMOs
2. Senior Clinician presence is critical to
developing a strong handover culture in the
hospital
3. Prompt arrival and attendance for the
duration of handover is necessary
4. Accessibility and approachability of senior
clinicians promotes learning
Handover facilitation guide
for senior clinicians
5. Teach a 5-minute ‘clinical pearl’ when possible during
handover
6. Review emergency team calls to critically unwell
patients
7. Use the patients at handover as a stimulus to teaching
8. Give non-judgemental feedback on the management of
unwell patients
9. Management suggestions on common clinical scenarios
will improve patient care, help JMO confidence in
clinical management, and reduce JMO anxiety at work
Themes
4. Patient safety and continuity of care
1. “Knowing the sick patients before they go off”
[Intern]
2. clearer guidance on complex patients making it
“easier with the management plan” [Intern]
3. improved continuity of team management plans
4. education about optimal management of
common clinical scenarios
Strengths & Weaknesses
• Qualitative findings not yet quantitatively
assessed
? generalisability
• ? observer bias
• Marked consistency of themes across
hospitals, rural to metroplitan
• First study to identify the motivational value
of handover as a key element to sustainability
• JMO researchers
Relevance
• NSW Health reported that this data collected
was most useful in handover project
implementation
• Represented a shift in the paradigm for
change – bottom up rather than top down
• For local implementation in consultation with
your JMOs
Summary
• JMOs feel that when shift-to-shift handover is
–Efficient,
–Educational,
–Facilitated by a senior clinician
• it is effective in improving patient safety and
continuity of care