The Role of Electronic Patient Record Systems in Clinical Handover Scenarios – What we can Learn from the Literature
Daniel FLEMMING[1], Ursula HÜBNER
University of Applied Sciences Osnabrück, Germany
Abstract.Handovers are instruments to ensure intra-institutional continuity of care between shifts. However, when not done properly they can lead to severe clinical problems. We therefore conducted a systematic literature review to identify approaches for improving handovers including electronic tools such as electronic patient records (EPR). Based on our findings we propose a handover EPR.
Keywords.handover, communication, nursing, electronic patient record
1.Introduction
Handovers are a complex communication scenario to ensure continuity of care by allowing clinicians to develop a common ground [1] about their patients. Although the function of electronic patient records (EPR) has widened from documentation to communication in the last years, the main purpose of a patient record is still to prove that a treatment has been performed [2]. They therefore mainly contain retrospective data.
The aim of this study is to firstly identify specific deficiencies of handovers and instruments to overcome these problemsand secondly to translate these findings into a concept for an EPR effectively supporting handovers.
2.Method
A structured review of the literature was performed with the keywords hand-off, handover, shift-report, sign-out in MEDLINE and CINAHL covering the publication years 1999 to 2010. The relevance and quality of the articles found was evaluated according to a scoring scheme.
3.Results
Handovers were described to be prone to information loss when they lacked structure and consistency [3] and to be prone to the omission of information in particular in the case of prospective information [4]. Although the quality of (retrospective) information exchanged was improved by automatically transferring data from the EPR to handover forms [5], there were no studies showing how prospective information should be represented in the EPR to support the specific needs during handover. We therefore propose a specific handover EPR to better integrate EPRs into the handover process. It represents a semi-persistent layer of transient and highly personalized informationand a layer of specific communication tools within the EPR architecture.
4.Discussion
Handovers link the past with the future and therefore require special electronic support for transmitting retrospective as well as prospective information and for allowingclinicians to interactively develop a common ground regarding their patients.
5.Conclusion
Based on the literature review a model for the handover EPR will be developed, which serves as a basis for developing and testing a handover EPR system.
References
[1]Parker J, Coiera E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc. 2000 Okt;7(5):453-461.
[2]Buckland MK. What is a "document"? J. Am. Soc. Inf. Sci. 1997 9;48(9):804-809.
[3]Bomba DT, Prakash R. A description of handover processes in an Australian public hospital. Aust Health Rev. 2005 Feb;29(1):68-79.
[4]Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch. Intern. Med. 2008 Sep 8;168(16):1755-1760.
[5]Anderson J, Shroff D, Curtis A, Eldridge N, Cannon K, Karnani R, u. a. The Veterans Affairs shift change physician-to-physician handoff project. JtComm J Qual Patient Saf. 2010 Feb;36(2):62-71.
[1]Corresponding Author: Daniel Flemming, University of Applied Sciences Osnabrück, Health Informatics Research Group, P.O. Box 1940, 49009 Osnabrueck, Germany; E-mail: