Junior Doctor Perceptions of

Clinical Handover the impact of efficiency, education and

senior clinician facilitation

Dr Hamish DunnDr Joanna Dargan

Dr Lucy Cho

Background• 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

Themes1. 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

Themes3. 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

clinicians1. Senior Clinicians’ handover input, feedback

and teaching are highly valued by JMOs2. 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

clinicians5. Teach a 5-minute ‘clinical pearl’ when possible during

handover 6. Review emergency team calls to critically unwell

patients7. Use the patients at handover as a stimulus to teaching8. Give non-judgemental feedback on the management of

unwell patients9. Management suggestions on common clinical scenarios

will improve patient care, help JMO confidence in clinical management, and reduce JMO anxiety at work

Themes4. 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 plans4. 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