Plain language summary
What is the best nursing handover style to ensure continuity of information for hospital patients?
What is a nursing handover?
A nursing handover occurs when one nurse hands over the responsibility of care for a patient to another nurse, for example, at the end of a nursing shift. On average, nursing handovers occur three times a day for each patient.
What styles of nursing handover exist?
In daily practice handovers are done in various ways, some handovers are done through nurses talking to each other (verbal handovers). Others are done through nurses reading the patient’s medical notes or through a combination of reading and talking to each other. In some cases they are done at the patient’s bedside, so that the patient can contribute, if desired.
Why does the style of nursing handovers need to be investigated?
When a nurse hands over responsibility of care to another nurse there is an opportunity for error if all the important medical information is not shared thoroughly and efficiently. Failing to mention - or grasp - information may result in delays in treatment or diagnosis for the patient, inappropriate treatment, or failure to provide appropriate care. Consequently, an accurate handover of clinical information is essential to ensure continuity of care and patients’ safety.
The purpose and findings of this review
This review tried to find out which nursing handover style works best.
In March 2013 the review authors conducted a wide search for suitable relevant studies (randomised controlled studies) that compared different styles of nursing handover. However, they were not able to identify any randomised controlled studies that investigated the question, and so could draw no conclusions. Further research in this area is urgently needed.
Résumé simplifié
Quel est le meilleur mode de transfert infirmier d’informations pour garantir la continuité de l’information pour les patients hospitalisés ?
Qu'est-ce qu'un transfert infirmier d’informations ?
Un transfert infirmier d’informations survient lorsqu'un infirmier transfère la responsabilité des soins d'un patient à un autre infirmier, par exemple à la fin du service. En moyenne, le transfert infirmier d’informations survient trois fois par jour pour chaque patient.
Quels types de transfert infirmier d’informations existent ?
Dans la pratique quotidienne, le transfert infirmier d’informations est réalisé de différentes manières. Parfois il se fait à travers un échange verbal entre infirmiers (transfert verbal). D'autres fois, le transfert est réalisé par la lecture du dossier médical du patient ou par une combinaison de la lecture et de la parole. Dans certains cas, le transfert est réalisé au chevet du patient, de sorte que celui-ci puisse contribuer, si nécessaire.
Pourquoi les différents types de transfert infirmier d’informations doivent être étudiés ?
Lorsqu'un infirmier confie la responsabilité des soins à un autre infirmier, des erreurs peuvent se produire si toutes les informations médicales importantes ne sont pas partagées de manière exhaustive et efficace. Echouer à mentionner ou à collecter des informations peut entraîner des retards de traitement ou de diagnostic pour le patient, un traitement inapproprié ou l’absence de soins appropriés. Par conséquent, le transfert exact d’informations cliniques est essentiel pour assurer la continuité des soins et la sécurité des patients.
L'objectif et les résultats de cette revue
Cette revue a essayé d'identifier les types de transfert infirmier d’informations qui fonctionnent le mieux.
En mars 2013, les auteurs de la revue ont réalisé une vaste recherche des études pertinentes à inclure (études contrôlées randomisées) qui comparaient différents types de transfert infirmier d’informations. Cependant, ils n’ont pas été en mesure d'identifier d'études contrôlées randomisées examinant cette question, et n’ont donc pu tirer aucune conclusion. Des recherches supplémentaires dans ce domaine sont urgemment nécessaires.
Notes de traduction
Traduit par: French Cochrane Centre 20th October, 2014
Traduction financée par: Financeurs pour le Canada : Instituts de Recherche en Santé du Canada, Ministère de la Santé et des Services Sociaux du Québec, Fonds de recherche du Québec-Santé et Institut National d'Excellence en Santé et en Services Sociaux; pour la France : Ministère en charge de la Santé
淺顯易懂的口語結論
哪一種護理交班方式最能確保住院病患的資訊連貫性？
什麼是護理交班？
當某位護理人員必須將照護某位病患的職責，交接予另一位護理人員時，就需要進行護理交班，例如護理人員下班時。一般而言，每位病患每天必須進行3次護理交班。
現行有哪些護理交班方式？
平常的護理交班有許多種方式，有些護理交班是透過某位護理人員告知另一位護理人員 (口頭交班)。其他的交班方式還包括病患病歷上的護理記錄，或同時進行書面記錄和口頭交班。有時會在病患的病床旁進行交班，如此病患也可以提出意見。
為什麼必須研究護理交班的方式？
當某位護理人員將照護職責移交給另一位護理人員時，若未有效率且完整傳遞重要的醫療資訊，就可能發生失誤。忘記提到或未能捕捉到資訊，可能延誤病患的治療或診斷、使病患接受不當治療，或無法提供適當照護。因此正確移交臨床資訊，對確保照護的連貫性和病患安全極為重要。
本次文獻回顧的目的和結果
本次文獻回顧試圖確認最適當的護理交班方式。
文獻回顧作者於2013年3月進行廣泛的搜尋，找尋合適的相關試驗 (隨機對照試驗)，比較各種護理交班方式。不過並未找到任何探究這個問題的隨機試驗，因此無法提出結論。此領域迫切需要進一步的研究。
譯註
翻譯者：臺北醫學大學實證醫學研究中心。
本翻譯計畫由衛生福利部補助經費，臺北醫學大學實證醫學研究中心、台灣實證醫學學會及東亞考科藍聯盟(EACA)統籌執行。
Laički sažetak
Koji je najbolji sestrinski stil primopredaje za osiguranje kontinuiteta informacija kod hospitaliziranih bolesnika?
Što je sestrinska primopredaja?
Sestrinska primopredaja se zbiva kad jedna medicinska sestra odgovornost za njegu pacijenta preda drugoj sestri, na primjer, nakon završene smjene. Prosječno se sestrinska primopredaja zbiva tri puta na dan za svakog pacijenta.
Kakvi stilovi sestrinske primopredaje postoje?
U svakodnevnoj praksi primopredaje se izvode na različite načine, pri čemu se neke primopredaje obavljaju kroz razgovor između medicinskih sestara (verbalna primopredaja). Druge se izvode kroz sestrinsko čitanje pacijentove dokumentacije ili kroz kombinaciju čitanja i razgovora među medicinskim sestrama. U nekim slučajevima to se radi pokraj pacijentova kreveta, kako bi i pacijent mogao nešto reći, ako želi.
Zašto treba istražiti stilove sestrinske primopredaje?
Kada medicinska sestra preda odgovornost za njegu drugoj sestri postoji mogućnost nastanka pogreške ako se sve važne medicinske informacije ne podijele temeljito i učinkovito. Zaboraviti spomenuti - ili shvatiti - informacije može dovesti do odgode liječenja ili postavljanja dijagnoze kod pacijenta, neprimjerenog liječenja, ili pogreške u pružanju odgovarajuće skrbi. Prema tome, važna je precizna primopredaja medicinskih informacija kako bi se osigurao kontinuitet skrbi i pacijentove sigurnosti.
Cilj i rezultati ovog Cochrane sustavnog pregleda
Ovaj Cochrane sustavni pregled pokušao je istražiti koji stil sestrinske primopredaje je najbolji.
U ožujku 2013. autori sustavnog pregleda napravili su opsežan pregled literature kako bi našli odgovarajuća istraživanja (nasumična kontrolirana ispitivanja) koja uspoređuju različite stilove sestrinske primopredaje. Međutim, nisu uspjeli pronaći nijedno nasumično kontrolirano istraživanje koje istražuje to pitanje, pa se ne može izvući nikakav zaključak. Daljnja istraživanja na ovom području su hitno potrebna.
Bilješke prijevoda
Cochrane Hrvatska
Prevela: Božena Armanda
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr
Laienverständliche Zusammenfassung
Welche ist die beste Möglichkeit der Pflegeübergabe im Krankenhaus um eine Kontinuität der Informationen in der Pflege sicherzustellen?
Was ist eine Pflegeübergabe?
Ein Pflegeübergabe erfolgt, wenn Pflegepersonal die Verantwortung der Pflege für einen Patienten auf anderes Pflegepersonal, zum Beispiel am Ende einer Schicht, übergibt. Durchschnittlich finden pro Patient dreimal täglich Pflegeübergaben statt.
Welche Möglichkeiten der Pflegeübergabe gibt es?
In der täglichen Praxis werden Pflegeübergaben auf verschiedene Art und Weise durchgeführt. Bei manchen spricht sich das Pflegepersonal ab (verbale Pflegeübergabe). In anderen Fällen, liest das Pflegepersonal die Notizen in der Patientenakte, oder das Lesen und die verbale Übergabe werden kombiniert. In manchen Fällen werden sie am Krankenbett durchgeführt, sodass der Patient, wenn gewünscht, auch etwas beitragen kann.
Warum muss die Art und Weise der Pflegeübergabe untersucht werden?
Wenn das Pflegepersonal die Verantwortung überträgt, besteht die Möglichkeit für Fehler, wenn nicht alle wichtigen medizinischen Informationen sorgfältig und effizient mitgeteilt werden. Wenn Informationen nicht erwähnt oder nicht verstanden werden, kann es dazu führen, dass die Behandlung oder Diagnose des Patienten verzögert wird, eine falsche Behandlung oder Pflege eingeleitet werden. Deswegen ist eine akkurate Pflegeübergabe essentiell für die Kontinuität der Pflege und der Sicherheit des Patienten.
Die Ziele und Ergebnisse dieses Reviews
Dieser Review hatte zum Ziel herauszufinden, welche Pflegeübergabe am besten funktioniert.
Im März 2013 führten die Autoren eine großangelegte Suche nach geeigneten, randomisierten kontrollierten Studien durch, die die unterschiedlichen Arten der Pflegeübergabe verglichen. Es wurden jedoch keine randomisierten kontrollierten Studien gefunden, die die Frage untersuchten, weshalb keine Schlussfolgerungen gezogen werden konnten. Mehr Forschung auf diesem Gebiet ist dringend notwendig.
Anmerkungen zur Übersetzung
I. Töws, Koordination durch Cochrane Schweiz.
Background
In its 2001 report, 'Crossing the Quality Chasm' the Institute of Medicine (IOM) stated that handovers provide an opportunity for error and that “in a safe system, information is not lost, inaccessible, or forgotten in transitions” (IOM 2001). In a 2009 hospital survey on patient safety-culture, hospital staff respondents reported that “important patient care information is often lost during shift changes and patient transfers” (AHRQ 2009). Inadequate and ineffective interpersonal communication between healthcare professionals is an often-cited key factor contributing to errors and procedural mistakes, which may lead to adverse events (AEs). Breakdowns in communication were implicated as one of the main causes of AEs reported to the Joint Commission in the USA between 2004 and 2010 (Joint Commission 2011). In an Australian study of more than 14,000 admissions, 17% were associated with an AE; in 11% of these communication problems were found to be a contributing factor (Wilson 1995).
Handovers of patient care thus introduce a 'vulnerable gap' that may result in AEs if clinically relevant information is not shared accurately and in a timely manner (Bhabra 2007; Handover Europe 2011; Pothier 2005). Other consequences of a poor handover might be delays in diagnosis or treatment (Joint Commission 2002), inappropriate treatment and omission of care. However, inefficiency due to rework, redundant communications and activities, may result in lower satisfaction for both healthcare provider and patient, increased costs, increased length of hospital stay and more readmissions (Patterson 2010). As a result, it is now well recognised that an accurate handover of clinical information is of great importance to continuity and safety of care.
This review will focus on the nursing handover as an instrument for ensuring continuity of care for hospitalised patients. This specific scope is chosen as nurses are pivotal in ensuring continuity of care in a 24-hour seven-days-a-week environment, not only since they are present both day and night (Messam 2009), but also because they are seen as a communication partner for all healthcare professionals and are often the (in)formal co-ordinators of the increasingly complex care that is given within hospitals (IOM 2010). To fulfil this role a complete and up to date picture of the patient's care plan has to be handed over frequently - on average three times a day and two times during each nurse's shift - and, due to frequent part-time working among nurses, handovers occur between many different nurses. Usually handovers are time-consuming, lack consistency and are varied in style (Clark 2009; Kerr 2011; Sexton 2004), and nursing handovers are no different. Furthermore, nurses, just like most healthcare professionals, may receive no formal training in the handover process other than by modelling from peers and superiors (Van Eaton 2010). As a consequence, the nursing handover is a vulnerable process with potential to result in AEs, unnecessary duplication of work or sub-optimal care.
Although the literature so far has not provided a thorough or agreed definition of the concept of handover and its scope, continuity of patient care is its primary function (Sherlock 1995; Thurgood 1995). The distinctive feature that distinguishes a handover from other (in)formal communication about patients is the transfer of professional responsibility for the patient (Cohen 2010). Responsibility deals with the transfer of accountability for the quality, safety and satisfaction of the patient. Within this review we define a handover as the exchange of specific information about a patient from one health professional to another, or from one team of health professionals to another, accompanied by the transfer of responsibility for that patient with the purpose of ensuring the continuity and safety of the patient's care (Cohen 2010; Jeffcott 2009). The scope of this review covers the exchange of information about content (the 'what' aspect), as well as the way, or method, in which it is communicated (the 'how' aspect) (Murphy 2009). Content can be structured (e.g. templates, mnemonics, checklists, or a combination of these) or unstructured. Method refers to the communication methods, e.g. verbal, written or taped. In addition to the content and method, the location (the ‘where’ aspect) of the handover may also differ. Location can be either bedside or office-based. We define a handover style as any combination of the above-mentioned characteristics, that is, content ('what'), method ('how') and location ('where') (Kerr 2002; Sexton 2004).
Literature frequently identifies the following nursing handover styles: bedside, verbal, nonverbal and taped (Messam 2009).
Bedside: located at the patient’s bedside, which promotes patient and nurse face-to-face interaction and encourages patients’ verbal participation, thus making the patient central to the information exchange process (Greaves 1999; Kassean 2005).
Verbal: located in an office setting, the nurse responsible for a group of patients exchanges relevant documented information (Bourne 2000; Lally 1999).
Non-verbal: located in an office setting, nurses inform themselves by reading the patient health record, involving progress notes, medication charts, observation charts and nursing care plans (Taylor 2002).
Taped: located in an office setting, the nurse in charge collects the relevant information and records this onto an audiotape so that the oncoming shift can listen at a convenient time (Dowding 2001).
During the last decade the call for interventions to improve handovers has increased (AMA 2006; AHRQ 2009; BMA 2005; IOM 2001; Joint Commission 2002; WHO 2006). These interventions aim to reduce the risk of miscommunication, misunderstanding and the omission of critical information, therefore, it is important to find out what constitutes an effective nursing handover style (Patterson 2010; Riesenberg 2010).
Description of the condition
As mentioned above, handovers of patient care may result in AEs if clinically relevant information is not shared accurately and in a timely manner. Other consequences of a less than perfect handover might be delays in treatment and diagnosis, inappropriate treatment and omission of care. However, inefficiency due to rework, redundant communications and redundant activities may also result in lower satisfaction for both healthcare provider and patient, increased costs, increased length of hospital stay and more readmissions.
Description of the intervention
We considered any nursing handover style (‘what’, ‘how’ and ‘where’) between nurses in a hospital setting with the aim of preventing AEs or optimising the transfer of accurate essential information required for continuity of care, or both. This includes:
nurses' shift changes on nursing wards providing different levels of care, such as: regular ward-based care, high-dependency care and intensive care unit (ICU);
nurse-to-nurse transfers during a shift to balance workload;
nurse-to-nurse interdepartmental transfers, such as between nursing wards, from the emergency department (ED) to the nursing ward, from the recovery unit to the nursing ward, from the ICU to the nursing ward or the other way round.
The review does not include:
handover from a primary care setting to a hospital setting by a primary care physician or from the ambulance to the ED;
handovers across different health professional groups, such as from a physician to a nurse;
handovers from hospital to home or to another healthcare facility upon discharge.
How the intervention might work
Generally handover interventions aim to incorporate a tool or routine into practice that implements a standardised approach to the handover, including written information and standardised communication patterns allowing for questions or for information to be read back. Use of the tool or routine is intended to support the exchange or availability of information about the patient (or both) for the next caregiver, resulting in improved continuity of care through:
improved recall of information provided;
improved compliance with the plan of care;
improved patient involvement;
timely delivery of the care;
a decrease in incongruent information (information given at handover that is different from the actual condition);
a decrease in omissions (information that if left out of the handover that could increase inefficiency);
a reduction of time spent resolving issues from incomplete communication at handover.
Therefore, an effective and efficient handover style may reduce the number of AEs and inefficiencies resulting from an ineffective handover, and also reduce the amount of time spent on handovers, thereby freeing-up time that can be spent in direct patient care (Sexton 2004).
Why it is important to do this review
Since handovers have been identified as a primary communication moment, many organisations, institutions and hospitals have initiated quality projects to improve handovers. In the 'High 5s Project', launched by the World Health Organization (WHO) in 2006, one of the five patient safety problems targeted was 'Communication failures during patient handovers' (WHO 2006). Literature on handovers is accumulating and thus it is important to understand the effectiveness of interventions aimed at improving nursing handovers and consequently ensuring continuity of care, as well as preventing AEs. Since the WHO and national government agencies are promoting handover interventions to improve patient safety (WHO 2007), these policy decisions should be based on evidence of the effectiveness of these interventions. There are risks involved in implementing interventions for which evidence of effectiveness is lacking: valuable resources can be wasted and clinicians might become reluctant to implement other measures. The aim of this review is to synthesise the evidence from high-quality studies in order to determine the most effective nursing handover style.
Appendices
Appendix 1. EPOC Specialised Register
1 All Non-Indexed fields {continuity of care} AND {communicat\*} AND {nurse} OR
2 All Non-Indexed fields {handover} OR{hand\* over} OR {hand\* off} OR {handoff} OR
3 All Non-Indexed fields {bedside report\*} OR {bed side report\*} OR {chang\* of shift} OR {changing shift\*} OR {shift chang\*} OR
4 All Non-Indexed fields {shift report\*} OR {sign out} report\*} OR {sign out system} OR {transfer report} OR {intershift} OR {inter-shift\*} OR
5 All Non-Indexed fields {patient\*} AND {transfer\*} AND {nurse} OR
6 All Non-Indexed fields {patient\* care} AND {communicat\*} OR
7 All Non-Indexed fields {patient|* care} AND {transfer\*} OR
8 All Non-Indexed fields {discharge planning} AND {nurse} OR
9 All Non-Indexed fields {patient discharg\*} AND {nurse} OR
10 Title, primary {patient} AND {transfer} OR
11 All Non-Indexed fields {care transition} OR {transition of care} OR
12 All Non-Indexed fields {interfacility} AND {transfer} OR
13 All Non-Indexed fields {inter-facility} AND {transfer} OR
14 Keywords patient transfer* OR
15 All Non-Indexed fields {care transition} OR {transition\*} OR {transition of care}
Appendix 2. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy
#1 (Interfacility or inter-facility or intra-hospital or intrahospital):ti,ab,kw
#2 (interprofessional or inter-professional or interdepartment* or inter-department*):ti,ab,kw
#3 (#1 OR #2)
#4 (patient* near/3 transfer*)
#5 (sign-over* or service change* ):ti,ab,kw
#6 (care near/2 transition*):ti,ab,kw
#7 MeSH descriptor Patient Transfer, this term only
#8 (#4 OR #5 OR #6 OR #7)
#9 (#3 AND #8)
#10 (#3 AND #8)
#1 (interprofessional or inter-professional or interdepartment* or inter-department*):ti,ab,kw
#2 (Interfacility or inter-facility or intra-hospital or intrahospital):ti,ab,kw
#3 (#1 OR #2)
#4 MeSH descriptor Patient Care Planning explode all trees
#5 MeSH descriptor Patient Care Management, this term only
#6 MeSH descriptor Patient-Centered Care, this term only
#7 MeSH descriptor Continuity of Patient Care, this term only
#8 MeSH descriptor Progressive Patient Care, this term only
#9 MeSH descriptor Critical Pathways, this term only
#10 (#4 OR #5 OR #6 OR #7 OR #8 OR #9)
#11 (#10 AND #3)
#1 "change-of-shift" or "bedside report*" or "bed-side report*":ti,ab,kw
#2 (transfer and report*):ti
#3 (#1 OR #2)
#1 "shift report*" or "sign-out report*"
#2 "sign* out*":ti,ab,kw
#3 "hand over*" or "handing over" or handover* or handoff* or "handing off" or "hand off*" or handoff* or "handing off" or "hand off*":ti,ab,kw
#4 (#1 OR #2 OR #3)
Appendix 3. MEDLINE search strategy
1. (hand over? or handing over or handover?).ti,ab.
2. "shift report*".ti,ab.
3. (handoff? or handing off or hand off?).ti.
4. (handoff? or handing off or hand off?).ab.
5. (shift adj3 chang*).ti,ab. and (patient? or care).ti,hw.
6. "sign-out report*".ti,ab.
7. (sign out adj2 (report* or system? or patient?)).ti,ab.
8. (sign out adj2 (report* or system?)).ti,ab.
9. (sign* out adj4 (nurse? or physician? or doctor? or resident? or patient?)).ti,ab.
10. or/1-9
11. (change-of-shift or (bedside report$ or bed-side report$)).ti,ab.
12. transfer report.ti. or (transfer report? adj3 (nurse? or doctor? or physician? or patient?)).ab.
13. ((intershift? or inter-shift? or shift?) adj2 report$).ti,ab.
14. or/11-13
15. Patient transfer/
16. (patient? and (transfer? or transport*)).ti.
17. (patient? adj3 (transfer$ or transport*)).ab.
18. ((interprofessional or inter-professional or interdepartment$ or inter-department$) adj2 transfer$).ti,ab.
19. sign-over?.ti,ab.
20. service change?.ti,ab.
21. (care adj2 transition$).ti,ab.
22. ((Interfacility or inter-facility or intra-hospital or intrahospital) adj3 transfer$).ti,ab.
23. (patient care management/ or exp patient care planning/ or patient-centered care/ or "continuity of patient care"/ or progressive patient care/ or critical pathways/) and ((patient adj2 transfer?) or shift chang$ or shift-to-shift).ti,ab.
24. or/15-23
25. exp Nursing/
26. exp nurses/ or nurse administrators/ or nurse anesthetists/ or nurse clinicians/ or nurse midwives/ or nurse practitioners/ or nurses, male/
27. nursing staff/ or nursing staff, hospital/
28. exp Nursing Care/
29. (patient care/ or exp critical care/ or "episode of care"/ or exp hospitalization/ or exp life support care/ or exp long-term care/ or exp night care/ or palliative care/ or perinatal care/ or exp perioperative care/ or postnatal care/ or prenatal care/ or preoperative care/ or subacute care/ or exp terminal care/) and ((nurse? or nursing).ti. or (or/25-27))
30. (nurse? or nursing).ti,ab,hw.
31. or/25-30
32. 10 and 31
33. 14 and 31
34. 24 and 31
35. intervention?.ti. or (intervention? adj6 (clinician? or collaborat$ or community or complex or design$ or doctor? or educational or family doctor? or family physician? or family practitioner? or financial or GP or general practice? or hospital? or impact? or improv$ or individuali?e? or individuali?ing or interdisciplin$ or multicomponent or multi-component or multidisciplin$ or multi-disciplin$ or multifacet$ or multi-facet$ or multimodal$ or multi-modal$ or personali?e? or personali?ing or pharmacies or pharmacist? or pharmacy or physician? or practitioner? or prescrib$ or prescription? or primary care or professional$ or provider? or regulatory or regulatory or tailor$ or target$ or team$ or usual care)).ab.
36. (collaborativ$ or collaboration? or tailored or personali?ed).ti,ab.
37. (exp hospitals/ or exp Hospitalization/ or exp Patients/ or exp Nurses/ or exp Nursing/) and (study.ti. or evaluation studies as topic/)
38. demonstration project?.ti,ab.
39. (pre-post or "pre test$" or pretest$ or posttest$ or "post test$" or (pre adj5 post)).ti,ab.
40. (pre-workshop or post-workshop or (before adj3 workshop) or (after adj3 workshop)).ti,ab.
41. trial.ti. or ((study adj3 aim?) or "our study").ab.
42. (before adj10 (after or during)).ti,ab.
43. ("quasi-experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab,hw.
44. ("time series" adj2 interrupt$).ti,ab,hw.
45. (time points adj3 (over or multiple or three or four or five or six or seven or eight or nine or ten or eleven or twelve or month$ or hour? or day? or "more than")).ab.
46. pilot.ti.
47. Pilot projects/
48. (clinical trial or multicenter study).pt.
49. (multicentre or multicenter or multi-centre or multi-center).ti.
50. random$.ti,ab. or controlled.ti.
51. (control adj3 (area or cohort? or compar? or condition or group? or intervention? or participant? or study)).ab. not (controlled clinical trial or randomized controlled trial).pt.
52. "comment on".cm. or systematic review.ti. or literature review.ti. or editorial.pt. or letter.pt. or meta-analysis.pt. or news.pt. or review.pt.
53. exp animals/ not humans.sh.
54. (or/35-51) not (or/52-53)
55. (randomized controlled trial or controlled clinical trial).pt. or randomi?ed.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti.
56. exp animals/ not humans/
57. (rat or rats or mice or mouse or horse or equine or cow or bovine or pig or porcin*).ti,hw.
58. comment on.cm. or systematic review.ti. or literature review.ti. or editorial.pt. or meta-analysis.pt. or news.pt. or review.pt.
59. 55 not (or/56-58)
60. 54 not 59
61. 32 and 60 [epoc hand-over]
62. 33 and 60 [epoc shift]
63. 34 and 60 [epoc transfer]
64. 32 and 59 [rct hand-over]
65. 33 and 59 [rct shift]
66. 34 and 59 [rct transfer]
67. (handover? or "hand over?" or hand* over?).ti,ab. and (nurse or nurses or nursing).ti,hw.
68. ((nurse or nursing or nurses) adj3 (handover? or "hand over?" or hand* over?)).ti,ab.
69. ((patient? or inpatient? or outpatient?) adj3 (handover? or "hand over?" or hand* over?)).ti,ab.
70. or/67-69 [handover-ruim]
Appendix 4. EMBASE search strategy
1. (hand over? or handing over or handover?).ti,ab.
2. "shift report*".ti,ab.
3. (handoff? or handing off or hand off?).ti.
4. (handoff? or handing off or hand off?).ab.
5. (shift adj3 chang*).ti,ab. and (patient? or care).ti,hw.
6. "sign-out report*".ti,ab.
7. (sign out adj2 (report* or system? or patient?)).ti,ab.
8. (sign out adj2 (report* or system?)).ti,ab.
9. (sign* out adj4 (nurse? or physician? or doctor? or resident? or patient?)).ti,ab.
10. or/1-9
11. (change-of-shift or (bedside report$ or bed-side report$)).ti,ab.
12. transfer report.ti. or (transfer report? adj3 (nurse? or doctor? or physician? or patient?)).ab.
13. ((intershift? or inter-shift? or shift?) adj2 report$).ti,ab.
14. or/11-13
15. Patient transfer/
16. (patient? and (transfer? or transport*)).ti.
17. (patient? adj3 (transfer$ or transport*)).ab.
18. ((interprofessional or inter-professional or interdepartment$ or inter-department$) adj2 transfer$).ti,ab.
19. sign-over?.ti,ab.
20. service change?.ti,ab.
21. (care adj2 transition$).ti,ab.
22. ((Interfacility or inter-facility or intra-hospital or intrahospital) adj3 transfer$).ti,ab.
23. (patient care management/ or exp patient care planning/ or patient-centered care/ or "continuity of patient care"/ or progressive patient care/ or critical pathways/) and ((patient adj2 transfer?) or shift chang$ or shift-to-shift).ti,ab.
24. or/15-23
25. exp Nursing/
26. exp nurses/ or nurse administrators/ or nurse anesthetists/ or nurse clinicians/ or nurse midwives/ or nurse practitioners/ or nurses, male/
27. nursing staff/ or nursing staff, hospital/
28. exp Nursing Care/
29. (patient care/ or exp critical care/ or "episode of care"/ or exp hospitalization/ or exp life support care/ or exp long-term care/ or exp night care/ or palliative care/ or perinatal care/ or exp perioperative care/ or postnatal care/ or prenatal care/ or preoperative care/ or subacute care/ or exp terminal care/) and ((nurse? or nursing).ti. or (or/25-27))
30. (nurse? or nursing).ti,ab,hw.
31. or/25-30
32. 10 and 31
33. 14 and 31
34. 24 and 31
35. intervention?.ti. or (intervention? adj6 (clinician? or collaborat$ or community or complex or design$ or doctor? or educational or family doctor? or family physician? or family practitioner? or financial or GP or general practice? or hospital? or impact? or improv$ or individuali?e? or individuali?ing or interdisciplin$ or multicomponent or multi-component or multidisciplin$ or multi-disciplin$ or multifacet$ or multi-facet$ or multimodal$ or multi-modal$ or personali?e? or personali?ing or pharmacies or pharmacist? or pharmacy or physician? or practitioner? or prescrib$ or prescription? or primary care or professional$ or provider? or regulatory or regulatory or tailor$ or target$ or team$ or usual care)).ab.
36. (collaborativ$ or collaboration? or tailored or personali?ed).ti,ab.
37. (exp hospitals/ or exp Hospitalization/ or exp Patients/ or exp Nurses/ or exp Nursing/) and (study.ti. or evaluation studies as topic/)
38. demonstration project?.ti,ab.
39. (pre-post or "pre test$" or pretest$ or posttest$ or "post test$" or (pre adj5 post)).ti,ab.
40. (pre-workshop or post-workshop or (before adj3 workshop) or (after adj3 workshop)).ti,ab.
41. trial.ti. or ((study adj3 aim?) or "our study").ab.
42. (before adj10 (after or during)).ti,ab.
43. *experimental design/ or *pilot study/ or quasi experimental study/
44. ("quasi-experiment$" or quasiexperiment$ or "quasi random$" or quasirandom$ or "quasi control$" or quasicontrol$ or ((quasi$ or experimental) adj3 (method$ or study or trial or design$))).ti,ab.
45. ("time series" adj2 interrupt$).ti,ab.
46. (time points adj3 (over or multiple or three or four or five or six or seven or eight or nine or ten or eleven or twelve or month$ or hour? or day? or "more than")).ab.
47. pilot.ti.
48. (multicentre or multicenter or multi-centre or multi-center).ti.
49. random$.ti,ab. or controlled.ti.
50. "comment on".cm. or systematic review.ti. or literature review.ti. or editorial.pt. or letter.pt. or meta-analysis.pt. or news.pt. or review.pt.
51. (animal/ or animal.hw.) not ((animal/ or animal?.kw,hw.) and (human/ or human?.hw,kw.))
52. (or/35-49) not (or/50-51)
53. randomized controlled trials/ or controlled clinical trials/ or randomi?ed.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti.
54. exp animals/ not humans/
55. (rat or rats or mice or mouse or horse or equine or cow or bovine or pig or porcin*).ti,hw.
56. (comment on or systematic review or literature review).ti. or editorial.pt. or meta-analysis/ or news.ti. or review.pt.
57. 53 not (or/54-56)
58. 52 not 57
59. 32 and 58 [epoc handover]
60. 33 and 58 [epoc shift]
61. 34 and 58 [epoc transfer]
62. 32 and 57 [rct handover]
63. 33 and 57 [rct shift]
64. 34 and 57 [rct transfer]
65. (handover? or "hand over?" or hand* over?).ti,ab. and (nurse or nurses or nursing).ti,hw.
66. ((nurse or nursing or nurses) adj3 (handover? or "hand over?" or hand* over?)).ti,ab.
67. ((patient? or inpatient? or outpatient?) adj3 (handover? or "hand over?" or hand* over?)).ti,ab.
68. or/65-67 [handover ruim]
Appendix 5. CINAHL search strategy
S84 s33 and s41 and s81
S83 s18 and s81
S82 s11 and s81
S81 s66 not s77
S80 S33 and S41 and S77
S79 S18 and S77
S78 S11 and S77
S77 S71 or S72 or S73 or S74 or S75 or S76
S76 (MM "Clinical Trials+")
S75 TI ( “control* N1 clinical” or “control* N1 group*” or “control* N1 trial*” or “control* N1 study” or “control* N1 studies” or “control* N1 design*” or “control* N1 method*” ) or AB ( “control* N1 clinical” or “control* N1 group*” or “control* N1 trial*” or “control* N1 study” or “control* N1 studies” or “control* N1 design*” or “control* N1 method*” )
S74 TI controlled or AB controlled
S73 TI random* or AB random*
S72 TI ( “clinical study” or “clinical studies” ) or AB ( “clinical study” or “clinical studies” )
S71 TI ( (multicent* n2 design*) or (multicent* n2 study) or (multicent* n2 studies) or (multicent* n2 trial*) ) or AB ( (multicent* n2 design*) or (multicent* n2 study) or (multicent* n2 studies) or (multicent* n2 trial*) )
S70 S33 and S41 and S66
S69 S18 and S66
S68 S11 and S66
S67 (S42 or S43 or S44 or S45 or S46 or S47 or S48 or S49 or S50 or S51 or S52 or S53 or
S54 or S55 or S56 or S57 or S58 or S59 or S60 or S61 or S62 or S63 or S64 or S65 ) and (S11 and S66)
S66 S42 or S43 or S44 or S45 or S46 or S47 or S48 or S49 or S50 or S51 or S52 or S53 or
S54 or S55 or S56 or S57 or S58 or S59 or S60 or S61 or S62 or S63 or S64 or S65
S65 TI ( (time points n3 over) or (time points n3 multiple) or (time points n3 three) or (time points n3 four) or (time points n3 five) or (time points n3 six) or (time points n3 seven) or (time points n3 eight) or (time points n3 nine) or (time points n3 ten) or (time points n3 eleven) or (time points n3 twelve) or (time points n3 month*) or (time points n3 hour*) or (time points n3 day*) or (time points n3 "more than") ) or AB ( (time points n3 over) or (time points n3 multiple) or (time points n3 three) or (time points n3 four) or (time points n3 five) or (time points n3 six) or (time points n3 seven) or (time points n3 eight) or (time points n3 nine) or (time points n3 ten) or (time points n3 eleven) or (time points n3 twelve) or (time points n3 month*) or (time points n3 hour*) or (time points n3 day*) or (time points n3 "more than") )
S64 TI ( (control w3 area) or (control w3 cohort*) or (control w3 compar*) or (control w3 condition) or (control w3 group*) or (control w3 intervention*) or (control w3 participant*) or (control w3 study) ) or AB ( (control w3 area) or (control w3 cohort*) or (control w3 compar*) or (control w3 condition) or (control w3 group*) or (control w3 intervention*) or (control w3 participant*) or (control w3 study) )
S63 TI ( multicentre or multicenter or multi-centre or multi-center ) or AB random*
S62 TI random* OR controlled
S61 TI ( trial or (study n3 aim) or "our study" ) or AB ( (study n3 aim) or "our study" )
S60 TI ( pre-workshop or preworkshop or post-workshop or postworkshop or (before n3 workshop) or (after n3 workshop) ) or AB ( pre-workshop or preworkshop or post-workshop or postworkshop or (before n3 workshop) or (after n3 workshop) )
S59 TI ( demonstration project OR demonstration projects OR preimplement* or pre-implement* or post-implement* or postimplement* ) or AB ( demonstration project OR demonstration projects OR preimplement* or pre-implement* or post-implement* or postimplement* )
S58 TX (intervention n6 clinician*) or (intervention n6 community) or (intervention n6 complex) or (intervention n6 design*) or (intervention n6 doctor*) or (intervention n6 educational) or (intervention n6 family doctor*) or (intervention n6 family physician*) or (intervention n6 family practitioner*) or (intervention n6 financial) or (intervention n6 GP) or (intervention n6 general practice*) Or (intervention n6 hospital*) or (intervention n6 impact*) Or (intervention n6 improv*) or (intervention n6 individualize*) Or (intervention n6 individualise*) or (intervention n6 individualizing) or (intervention n6 individualising) or (intervention n6 interdisciplin*) or (intervention n6 multicomponent) or (intervention n6 multi-component) or (intervention n6 multidisciplin*) or (intervention n6 multi-disciplin*) or (intervention n6 multifacet*) or (intervention n6 multi-facet*) or (intervention n6 multimodal*) or (intervention n6 multi-modal*) or (intervention n6 personalize*) or(intervention n6 personalise*) or (intervention n6 personalizing) or (intervention n6 personalising) or (intervention n6 pharmaci*) or (intervention n6 pharmacist*) or (intervention n6 pharmacy) or (intervention n6 physician*) or (intervention n6 practitioner*) Or (intervention n6 prescrib*) or (intervention n6 prescription*) or (intervention n6 primary care) or (intervention n6 professional*) or (intervention* n6 provider*) or (intervention* n6 regulatory) or (intervention n6 regulatory) or (intervention n6 tailor*) or (intervention n6 target*) or (intervention n6 team*) or (intervention n6 usual care)
S57 TI ( collaborativ* or collaboration* or tailored or personalised or personalized ) or AB ( collaborativ* or collaboration* or tailored or personalised or personalized )
S56 TI pilot
S55 (MH "Pilot Studies")
S54 AB "before-and-after"
S53 AB time series
S52 TI time series
S51 AB ( before* n10 during or before n10 after ) or AU ( before* n10 during or before n10 after )
S50 TI ( (time point*) or (period* n4 interrupted) or (period* n4 multiple) or (period* n4 time) or (period* n4 various) or (period* n4 varying) or (period* n4 week*) or (period* n4 month*) or (period* n4 year*) ) or AB ( (time point*) or (period* n4 interrupted) or (period* n4 multiple) or (period* n4 time) or (period* n4 various) or (period* n4 varying) or (period* n4 week*) or (period* n4 month*) or (period* n4 year*) )
S49 TI ( ( quasi-experiment* or quasiexperiment* or quasi-random* or quasirandom* or quasi control* or quasicontrol* or quasi* W3 method* or quasi* W3 study or quasi* W3 studies or quasi* W3 trial or quasi* W3 design* or experimental W3 method* or experimental W3 study or experimental W3 studies or experimental W3 trial or experimental W3 design* ) ) or AB ( ( quasi-experiment* or quasiexperiment* or quasi-random* or quasirandom* or quasi control* or quasicontrol* or quasi* W3 method* or quasi* W3 study or quasi* W3 studies or quasi* W3 trial or quasi* W3 design* or experimental W3 method* or experimental W3 study or experimental W3 studies or experimental W3 trial or experimental W3 design* )
S48 TI pre w7 post or AB pre w7 post
S47 MH "Multiple Time Series" or MH "Time Series"
S46 TI ( (comparative N2 study) or (comparative N2 studies) or evaluation study or evaluation studies ) or AB ( (comparative N2 study) or (comparative N2 studies) or evaluation study or evaluation studies )
S45 MH Experimental Studies or Community Trials or Community Trials or Pretest-Posttest Design + or Quasi-Experimental Studies + Pilot Studies or Policy Studies + Multicenter Studies
S44 TI ( pre-test* or pretest* or posttest* or post-test* ) or AB ( pre-test* or pretest* or posttest* or "post test* ) OR TI ( preimplement*" or pre-implement* ) or AB ( pre-implement* or preimplement* )
S43 TI ( intervention* or multiintervention* or multi-intervention* or postintervention* or post-intervention* or preintervention* or pre-intervention* ) or AB ( intervention* or multiintervention* or multi-intervention* or postintervention* or post-intervention* or preintervention* or pre-intervention* )
S42 (MH "Quasi-Experimental Studies")
S41 S34 or S35 or S36 or S37 or S38 or S39 or S40
S40 AB interprofessional or inter-professional or interdepartment* or inter-department*
S39 TI interprofessional or inter-professional or interdepartment* or inter-department*
S38 AB Interfacility or inter-facility or intra-hospital or intrahospital
S37 TI Interfacility or inter-facility or intra-hospital or intrahospital
S36 TX patient unit*
S35 (MH "Interprofessional Relations+")
S34 (MH "Transfer, Intrahospital")
S33 S19 or S20 or S21 or S22 or S23 or S24 or S25 or S26 or S27 or S32
S32 S28 and S31
S31 S29 or S30
S30 AB patient N2 transfer* or shift chang* or shift-to-shift
S29 TI patient N2 transfer* or shift chang* or shift-to-shift
S28 (MH "Patient Care Plans+") OR (MH "Patient Centered Care") OR (MH "Continuity of Patient Care+") OR (MH "Progressive Patient Care") OR (MH "Critical Path")
S27 AB care N2 transition*
S26 TI care N2 transition*
S25 AB "service change"
S24 TI "service change"
S23 AB sign over
S22 TI sign over
S21 AB patient N3 transfer* or patient N3 transport*
S20 TI patient and transfer?
S19 (MH "Discharge Planning+")
S18 S12 or S13 or S14 or S15 or S16 or S17
S17 TI intershift? N3 report* or inter-shift? N3 report* or shift* N3 report*
S16 AB intershift? N3 report* or inter-shift? N3 report* or shift* N3 report*
S15 AB transfer N3 report*
S14 TI transfer N3 report*
S13 TI change-of-shift or "bedside report*" or "bed-side report*"
S12 AB change-of-shift or "bedside report*" or "bed-side report*"
S11 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10
S10 AB hand over? or handing over or handover?
S9 TI hand over? or handing over or handover?
S8 AB "shift report*" or "sign-out report*"
S7 AB (shift N3 chang*) and (patient? or care)
S6 AB sign out
S5 TI sign out
S4 TI (shift N3 chang*) and (patient? or care)
S3 TI "shift report*" or "sign-out report*"
S2 AB handoff? or handing off or hand off?
S1 TI handoff? or handing off or hand off?
Appendix 6. ISI Web of Knowledge search strategy
1 Topic=(handover*) AND Topic=(patient or patients or nurse or nurses or hospital* or healthcare or "health care") NOT Title=("Nursing Home*")
2 (TI=handover* AND (TI=patient* or TI=hospital* or TI=nurse or TI=nurses or TI=healthcare or TI=care)) NOT ti="nursing home*" Databases=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH Timespan=All Years Lemmatization=On
3 ((TI=HANDOFF* OR ts=HANDOFF*) and (ti=NURSE OR TI=NURSES OR TI=HOSPITAL* OR TI=CARE OR TI=PATIENT* OR TI=INPATIENT* OR TS=NURSE OR TS=NURSES OR TS=HOSPITAL* OR TS=CARE OR TS=PATIENT* OR TS=INPATIENT)) NOT (TI=NURSING HOME* OR TS=NURSING HOME*)
Databases=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH Timespan=All Years Lemmatization=On
Appendix 7. Systematic reviews for which the authors searched the reference lists
| | Authors | Title |
| 1 | Arora VM, Manjarrez E, Dressler DD, Basaviah P, Halasyamani L, Kripalani S | Hospitalist handoffs: a systematic review and task force recommendations. Journal of Hospital Medicine 2009;4(7):433-40 |
| 2 | Benson E, Rippin-Sisler C, Jabusch K, Keast S | Improving nursing shift-to-shift report. Journal of Nursing Care Quality 2007;22(1):80-4 |
| 3 | Calleja P, Aitken LM, Cooke ML | Information transfer for multi-trauma patients on discharge from the emergency department: mixed-method narrative review. Journal of Advanced Nursing 2011;67(1):4-18 |
| 4 | Cohen MD, Hilligoss PB | The published literature on handoffs in hospitals: deficiencies identified in an extensive review. Quality & Safety in Health Care 2010;19(6):493-7 |
| 5 | Collins SA, Stein DM, Vawdrey DK, Stetson PD, Bakken S | Content overlap in nurse and physician handoff artifacts and the potential role of electronic health records: a systematic review. Journal of Biomedical Informatics 2011;44(4):704-12 |
| 6 | Foster S, Manser T | The effects of patient handoff characteristics on subsequent care: a systematic review and areas for future research. Academic Medicine 2012;87(8):1105-24 |
| 7 | Fraser LE, O'Brien K, Tobar I, Waller DM | Patient care plans for intershift report. Journal of Pediatric Nursing 1991;6(5):310-6 |
| 8 | Gordon M, Findley R | Educational interventions to improve handover in health care: a systematic review. Medical Education 2011;45(11):1081-9 |
| 9 | Hoban V | How to ... handle a handover. Nursing Times 2003;99(9):54-5 |
| 10 | Kalkman C | Handover in the perioperative care process. Current Opinion in Anesthesiology 2010;23(6):749-53 |
| 11 | Manser T, Foster S | Effective handover communication: an overview of research and improvement efforts. Best Practice & Research Clinical Anaesthesiology 2011;25(2):181-91 |
| 12 | Matic J, Davidson, PM, Salamonson Y | Review: bringing patient safety to the forefront through structured computerisation during clinical handover. Journal of Clinical Nursing 2011;20(1-2):184-9 |
| 13 | McKenna LG. | Improving the nursing handover report. Professional Nurse 1997;12(9):637-9 |
| 14 | Messam K, Pettifer A | Understanding best practice within nurse intershift handover: what suits palliative care? International Journal of Palliative Nursing 2009;15(4):190-6 |
| 15 | Miller C | Ensuring continuing care: styles and efficiency of the handover process. The Australian Journal of Advanced Nursing 1998;16(1):23-7 |
| 16 | Ong MS, Coiera E | A systematic review of failures in handoff communication during intrahospital transfers. Joint Commission Journal on Quality & Patient Safety 2011;37(6):274-84 |
| 17 | Patterson ES, Wears, RL | Patient handoffs: standardized and reliable measurement tools remain elusive. Joint Commission Journal on Quality & Patient Safety 2010;36(2):52-61 |
| 18 | Priest CS, Holmberg SK | A new model for the mental health nursing change of shift report. Journal of Psychosocial Nursing and Mental Health Services 2000;38(8):36-43 |
| 19 | Raduma-Tomas MA, Flin R, Yule S, Williams D. | Doctors' handovers in hospitals: a literature review. BMJ Quality & Safety 2011;20(2):128-33 |
| 20 | Riesenberg LA, Leitzsch J, Cunningham JM | Nursing handoffs: a systematic review of the literature: surprisingly little is known about what constitutes best practice. The American Journal of Nursing 2010;110(4):24-36 |
| 21 | Scott P, Ross P, Prytherch D | Evidence-based inpatient handovers: a literature review and research agenda. Clinical Governance: An International Journal 2012;17(1):14-27 |
| 22 | Siemsen IM, Michaelsen L, Nielsen J, Ostergaard D, Andersen HB | [Patient handover involves numerous safety risks]. [Review] [Danish]. Ugeskr Laeger 2011;173(20):1412-6 |
| 23 | Staggers N | An integrative review of research on nursing handoffs in acute care settings... Transitions: Unifying Practice, Education, and Research to Improve Health: Communicating Nursing Research 2011;44:27-42 |
| 24 | Strople B, Ottani P | Can technology improve intershift report? What the research reveals. Journal of Professional Nursing 2006;22:197-204 |
| 25 | Watkins S | Introducing bedside handover reports. Professional Nurse 1997;12(4):270-3 |
| 26 | Woodward HI, Mytton OT, Lemer C, Yardley IC, Ellis BM, Rutter PD, et al | What have we learned about interventions to reduce medical errors? Annual Review of Public Health 2010;31:479-97 |
| 27 | Wong MC, Yee KC, Turner P | Clinical Handover Literature Review, eHealth Services Research Group, University of Tasmania, Australia, 2008 |
