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Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
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2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 3, 172-178 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Communication errors cause clinical inci-dents and adverse events in relation to surgery. To ensureproper postoperative patient care, it is essential that person-nel remember and recall information given during the hand-over from the operating theatre to the postanaesthesia careunit. Formalizing the handover may improve communicationand aid memory, but research in this area is lacking.OBJECTIVE The objective of this study was to evaluatewhether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affectsreceivers’ information retention after postoperative handover.DESIGN A prospective intervention study with an interven-tion group and comparison nonintervention group, withassessments before and after the intervention.SETTING The postanaesthesia care units of two hospitals inSweden during 2011 and 2012.PARTICIPANTS Staff involved in the handover between theoperating theatre and the postanaesthesia care units withineach hospital.INTERVENTION Implementation of the communication toolSBAR in one hospital.MAIN OUTCOME MEASURES The main outcome was thepercentage of recalled information sequences among recei-vers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specificprotocol form.RESULTS Preintervention, 73 handovers were observed(intervention group, n 1⁄4 40; comparison group, n 1⁄4 33)involving 72 personnel (intervention group, n 1⁄4 40; com-parison group, n 1⁄4 32). Postintervention, 91 handoverswere observed (intervention group, n 1⁄4 44; comparisongroup, n 1⁄4 47) involving 57 personnel (intervention group,n 1⁄4 31; comparison group, n 1⁄4 26). In the interventiongroup, the percentage of recalled information sequencesby the receivers increased from 43.4% preintervention to52.6% postintervention (P 1⁄4 0.004) and the SBAR struc-ture improved significantly (P 1⁄4 0.028). In the comparisongroup, the corresponding figures were 51.3 and 52.6%(P 1⁄4 0.725) with no difference in SBAR structure. When alinear regression generalised estimating equation modelwas used to account for confounding influences, we wereunable to show a significant difference in the informationrecalled between the intervention group and the noninter-vention group over time.CONCLUSION Compared with the comparison group withno intervention, when SBAR was implemented in an anaes-thetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover.

Place, publisher, year, edition, pages
2016. Vol. 33, no 3, 172-178 p.
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-273677DOI: 10.1097/EJA.0000000000000335ISI: 000369548100003PubMedID: 26760400OAI: oai:DiVA.org:uu-273677DiVA: diva2:894906
Available from: 2016-01-16 Created: 2016-01-16 Last updated: 2017-11-30Bibliographically approved
In thesis
1. Communication and Patient Safety: Transfer of information between healthcare personnel in anaesthetic clinics
Open this publication in new window or tab >>Communication and Patient Safety: Transfer of information between healthcare personnel in anaesthetic clinics
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective.

The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews.

The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV).

The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1186
Keyword
anaesthesiologist, anaesthetic clinic, communication, handover, incident reports, information transfer, interruption, memory, nurse, operating theatre, patient safety, post-anaesthesia care unit, safety attitudes, SBAR
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-278726 (URN)978-91-554-9489-6 (ISBN)
Public defence
2016-04-20, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-03-24 Created: 2016-02-25 Last updated: 2016-04-04

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Randmaa, MariaSwenne, Christine LMårtensson, GunillaEngström, Maria

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