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  • 1.
    Randmaa, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Communication and Patient Safety: Transfer of information between healthcare personnel in anaesthetic clinics2016Doctoral 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.  

    List of papers
    1. An observational study of postoperative handover in anesthetic clinics: the content of verbal information and factors influencing receiver memory
    Open this publication in new window or tab >>An observational study of postoperative handover in anesthetic clinics: the content of verbal information and factors influencing receiver memory
    2015 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 2, p. 105-115Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    The aim was to examine the handover process in the postanesthesia care unit, how much the receiver remembered, and what factors influenced memory.

    Design

    An observational study with a descriptive and correlational design.

    Methods

    A total of 73 handovers were investigated, and data were collected using observation, audiotape recordings of the handovers, and the patient's anesthetic record.

    Finding

    Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with receivers' retention of information were structure and handover duration.

    Conclusion

    Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

    National Category
    Nursing
    Identifiers
    urn:nbn:se:uu:diva-220262 (URN)10.1016/j.jopan.2014.01.012 (DOI)000351842600002 ()25813296 (PubMedID)
    Available from: 2014-03-12 Created: 2014-03-12 Last updated: 2020-03-04
    2. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study
    Open this publication in new window or tab >>SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study
    2014 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 1, article id e004268Article in journal (Refereed) Published
    Abstract [en]

    Objectives

    We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

    Design

    A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

    Setting

    Anaesthetic clinics at two hospitals in Sweden.

    Participants

    All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and postanaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

    Intervention

    Implementation of SBAR in an anaesthetic clinic.

    Primary and secondary outcomes

    The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

    Results

    In the intervention group, there were statistically significant improvements in the factors ‘Between-group communication accuracy’ (p=0.039) and ‘Safety climate’ (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

    Conclusions

    Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:uu:diva-220257 (URN)10.1136/bmjopen-2013-004268 (DOI)000337363700043 ()
    Available from: 2014-03-12 Created: 2014-03-12 Last updated: 2023-08-28Bibliographically approved
    3. Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers
    Open this publication in new window or tab >>Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers
    Show others...
    2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 3, p. 172-178Article 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.

    National Category
    Nursing
    Identifiers
    urn:nbn:se:uu:diva-273677 (URN)10.1097/EJA.0000000000000335 (DOI)000369548100003 ()26760400 (PubMedID)
    Available from: 2016-01-16 Created: 2016-01-16 Last updated: 2020-03-04Bibliographically approved
    4. Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses
    Open this publication in new window or tab >>Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Anaesthetic clinic, Handover, Postoperative, Qualitative study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-277616 (URN)
    Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2016-04-04
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  • 2.
    Randmaa, Maria
    et al.
    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, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Swenne, Christine Leo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 8, article id e015038Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate different professionals' (nurse anaesthetists', anaesthesiologists', and postanaesthesia care unit nurses') descriptions of and reflections on the postoperative handover.

    DESIGN: A focus group interview study with a descriptive design using qualitative content analysis of transcripts.

    SETTING: One anaesthetic clinic at two hospitals in Sweden.

    PARTICIPANTS: Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).

    RESULTS: Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals' perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing.

    CONCLUSIONS: The present findings revealed variations in different professionals' views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals' perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.

    Download full text (pdf)
    fulltext
  • 3.
    Randmaa, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Leo Swenne, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study2014In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 1, article id e004268Article in journal (Refereed)
    Abstract [en]

    Objectives

    We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.

    Design

    A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.

    Setting

    Anaesthetic clinics at two hospitals in Sweden.

    Participants

    All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and postanaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.

    Intervention

    Implementation of SBAR in an anaesthetic clinic.

    Primary and secondary outcomes

    The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.

    Results

    In the intervention group, there were statistically significant improvements in the factors ‘Between-group communication accuracy’ (p=0.039) and ‘Safety climate’ (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.

    Conclusions

    Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.

  • 4.
    Randmaa, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Swennne, Christine Leo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    An observational study of postoperative handover in anesthetic clinics: the content of verbal information and factors influencing receiver memory2015In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 2, p. 105-115Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim was to examine the handover process in the postanesthesia care unit, how much the receiver remembered, and what factors influenced memory.

    Design

    An observational study with a descriptive and correlational design.

    Methods

    A total of 73 handovers were investigated, and data were collected using observation, audiotape recordings of the handovers, and the patient's anesthetic record.

    Finding

    Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with receivers' retention of information were structure and handover duration.

    Conclusion

    Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

  • 5.
    Randmaa, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Swenne, Christine L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Högberg, Hans
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 3, p. 172-178Article in journal (Refereed)
    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.

1 - 5 of 5
CiteExportLink to result list
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  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
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  • en-GB
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