Using the ISBAR Handover Tool in Junior Medical Officer Handover
Using the ISBAR Handover Tool in Junior Medical Officer Handover
Background Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting.
Objective To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital.
Methods JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration.
Results Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration.
Conclusions Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.
Handover is defined as the transfer of professional responsibility and accountability for the care of a patient. With increasing focus on safe working hours, demand for part-time work and the move towards multidisciplinary patient care, handover is occurring more frequently. A recent Australian study estimated that patients see an average of 6–10 doctors per admission. However, current handover practices are criticised as being highly variable, unstructured, and error-prone. International evidence suggests few trainees receive formal instruction on the handover process, and it is unknown how many medical students and junior doctors in Australia currently receive training or evaluation in handover. Inadequate handover has implications for patient care and safety, with communication failures identified as the root cause in over 70% of adverse hospital events.
A number of recommendations have been made on how to improve handover. These include ensuring a set time and place free of interruption, training sessions, senior supervision and use of electronic aids. One important recommendation is that handover should follow a standardised approach, such as the framework designated by the acronym 'ISBAR' (figure 1).
(Enlarge Image)
Figure 1.
Explanation of the acronym 'ISBAR'.
The ISBAR tool may improve handover by providing a template which creates a clear picture of the patient's clinical issues while also defining outstanding issues and tasks. It aids communication by offering an expected pattern of transferred information so errors or omitted information become clear. Studies on ISBAR have shown that it can have a substantial impact on improving the quality of handover. It is a well received, easy to remember tool, and has been shown to reduce rates of adverse events.
Despite handover practice being widely discussed in the literature, there is no substantial evidence to justify changes in practice. Furthermore, there are no published studies focusing on the use of ISBAR in handover between junior doctors, and no well established evidence base for best practice in handover between JMOs. The aim of this study was to assess the effect of the ISBAR handover tool on clinical handover between JMOs in a tertiary hospital setting, in terms of JMO perception of handover, transfer of key clinical information, and duration of handover.
Abstract and Introduction
Abstract
Background Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting.
Objective To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital.
Methods JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration.
Results Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration.
Conclusions Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.
Introduction
Handover is defined as the transfer of professional responsibility and accountability for the care of a patient. With increasing focus on safe working hours, demand for part-time work and the move towards multidisciplinary patient care, handover is occurring more frequently. A recent Australian study estimated that patients see an average of 6–10 doctors per admission. However, current handover practices are criticised as being highly variable, unstructured, and error-prone. International evidence suggests few trainees receive formal instruction on the handover process, and it is unknown how many medical students and junior doctors in Australia currently receive training or evaluation in handover. Inadequate handover has implications for patient care and safety, with communication failures identified as the root cause in over 70% of adverse hospital events.
A number of recommendations have been made on how to improve handover. These include ensuring a set time and place free of interruption, training sessions, senior supervision and use of electronic aids. One important recommendation is that handover should follow a standardised approach, such as the framework designated by the acronym 'ISBAR' (figure 1).
(Enlarge Image)
Figure 1.
Explanation of the acronym 'ISBAR'.
The ISBAR tool may improve handover by providing a template which creates a clear picture of the patient's clinical issues while also defining outstanding issues and tasks. It aids communication by offering an expected pattern of transferred information so errors or omitted information become clear. Studies on ISBAR have shown that it can have a substantial impact on improving the quality of handover. It is a well received, easy to remember tool, and has been shown to reduce rates of adverse events.
Despite handover practice being widely discussed in the literature, there is no substantial evidence to justify changes in practice. Furthermore, there are no published studies focusing on the use of ISBAR in handover between junior doctors, and no well established evidence base for best practice in handover between JMOs. The aim of this study was to assess the effect of the ISBAR handover tool on clinical handover between JMOs in a tertiary hospital setting, in terms of JMO perception of handover, transfer of key clinical information, and duration of handover.
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