Inter-department patient handoff quality and its contributing factors in Chinese hospitals

Abstract

The aims of the current study were to obtain factors contributing to inter-department patient handoff quality and to uncover characteristics of the current handoffs from the point of view of Chinese healthcare staff. A questionnaire was developed to obtain the staff’s views on inter-department handoffs. An online questionnaire survey was conducted between December 2016 and March 2017. A total of 490 valid responses were collected from physicians, nurses, and assistant nurses. Five handoff factors were derived by applying principal component analysis with 44% of cumulative variance accounted for. Significant differences were observed across three professional groups and assistant nurses had the most negative evaluations. However, a similar trend of views was shared, i.e., they showed a good understanding of their own roles and adequate communication during handoffs. In contrast, it was observed that patient care responsibility and information were sometimes discontinued. From the point of view of staff, the overall handoff quality was mainly affected by mutual communication, the handoff system and environment. The inadequacy of information transfer frequency was reported to be higher when receiving patients than when sending patients, particularly when receiving patients from the emergency or outpatient departments. Generally, healthcare staff in China had a high estimation of the overall quality and safety of inter-department patient handoffs. However, it was observed that information and responsibility were sometimes transferred inadequately. To resolve this discontinuity, we suggest a standardized handoff process, effective use of unlicensed staff and fostering a culture of error reporting and learning.

Appendix 1

Question items in Sect. 1 about inter-department patient handoffs

Q1. Regarding problems discovered during patient handoffs, my department/ward always finds solutions and solves them together with other relevant departments/wards.

Q2. My department/ward often has views different from others about what information is required for patient handoffs.

Q3. Current information technology supports patient handoffs well.

Q4. It is clear to me when responsibility for a patient is transferred.

Q5. In my department/ward, we always receive accurate and updated information in patient handoffs from other departments/wards involved.

Q6. I know what is expected of me in a patient handoff situation.

Q7. In my department/ward, new staff members always receive formal training for patient handoffs.

Q8. We have sufficient time to prioritize the information needed to make a safe patient handoff.

Q9. In my department/ward, it is a common practice that staff read back information they received and ask questions regarding unclear parts to ensure that the information is correctly understood.

Q10. In my department/ward, we are rarely interrupted during patient handoffs.

Q11. In my department/ward, we sometimes talk about having received too little information in patient handoffs.

Q12. My department/ward uses patient handoffs as an opportunity for junior staff to learn good clinical practice.

Q13. In my department/ward, we have written procedures/guidelines/instructions for patient handoffs.

Q14. It is sometimes unclear who is responsible for a patient after a patient handoff.

Q15. In my department/ward, patient safety has the highest priority for patient handoffs.

Q16. In my hospital, the patient handoff process needs improvement.

Q17. In patient handoffs, we always voice our own concerns and express our own opinions to share understanding with other handoff staff.

Q18. In my hospital, patient handoffs could be performed more efficiently.

Q19. We always inform our patients of their planned transfers to other departments/wards whenever they are capable of understanding this.

Q20. In my department/ward, sometimes we are too busy to attend quickly to a newly received patient.

Q21. In my department/ward, we always seek to obtain required information from patients themselves or their families.

Q22. In my department/ward, we usually do not make timely follow-up, support, and coordination after patient handoffs.

Q23. Sometimes, staff conducting a handoff with me is inexperienced or less capable.

Q24. In patient handoffs, it is a common practice that we discuss communications with patients/families to understand their complaints.

Q25. Overall, patient handoffs between departments/wards are conducted well in my hospital.