Developing a framework for nursing handover in the emergency department: an individualised and systematic approach

AIMS AND OBJECTIVES: To explore emergency department (ED) nurses' perceptions of current practices and essential components of effective change of shift nursing handover. BACKGROUND: Ineffective nursing handover can negatively impact on patient outcomes. Evidence suggests that nursing handover in ED is highly variable. Proposed handover models in the literature are structured for inpatient settings and may not be suitable for ED settings. DESIGN: A mixed methods study (survey and group interviews) was conducted in a metropolitan ED in Melbourne, Australia. METHODS: During February-June 2011, a survey (n = 63) investigated perceptions of current practices and preferences for handover structure. Analyses are descriptive. In the same period, group interviews (n = 41) explored nurses' opinions about essential features and information of an effective nursing handover in the ED environment. A modified nominal group technique generated data that were analysed using content analysis. RESULTS: Most nurses (96%) perceived receiving adequate information during handover; however, gaps were identified, including omission of important information regarding medications, vital signs and nursing care needs. Group interviews identified five essential features of effective handover: systematic approach, treatment, appropriate environment, reference to documentation/charts and efficient communication. Essential information included patient details, presenting problem, future care/disposition plan, treatment and nursing observations. CONCLUSION: Handover structures in the ED may not provide essential information to ensure adequate continuity of nursing care. ED nurses consider optimal handover to be specific for patients for whom they are caring, conducted at the bedside, structured and containing key elements (patient details, presenting problem, treatment, nursing observations, plan). RELEVANCE TO CLINICAL PRACTICE: Provision of a handover framework incorporating key features and essential information has the potential to improve the efficiency of handover. Use of this framework may enhance the transfer of accurate and essential information to enable safe and high standards of nursing care in the ED.