Factors Influencing the Quality of Emergency Department Nurse Shift Handover

Background: Nurse-to-nurse shift handover is defined as defined as bidirectional communication that results in the transfer of information and responsibility for a patient (Friesen et al., 2008; McFetridge et al., 2007; Tregunno, 2009). Nurse-to-nurse shift handover is an integral part of safe nursing care as incoming nurses depend on handover information to inform decision making, establish priorities, and to plan and provide patient care. The Emergency Department (ED) is a clinical area where nurse-to-nurse handover communication is particularly vulnerable as a result of the unpredictable, often chaotic nature of the environment. Although a large amount of handover literature is aimed at examining handover on inpatient units, there is little literature exploring nurse-to-nurse shift handover in the ED. Moreover, the majority of existing handover literature is focused on identifying handover interventions rather than identifying the factors that influence handover. It is only through understanding the factors that influence handover quality that effective interventions can be developed.

Objective: The aim of this research is to identify factors that influence the quality of nurse-to-nurse shift handover in the ED, as perceived by the incoming nurse.

Subject Population: A random sample of 650 Registered Nurses (RN) employed in Ontario Emergency Departments (ED) were invited to complete a mailed survey asking about factors influencing the last shift handover that was received.

Research Design: Data were collected using pencil and paper surveys mailed to participants’ homes. Surveys were mailed using a modified version of Dillman’s Tailored Design Method (Dillman et al., 2009). Survey items were based on literature review findings used to develop a hypothesized theoretical model of factors influencing handover communication. The hypothesized model included 18 factors hypothesized to directly influence the quality of handover, in addition to four interaction effects. The 83 item survey was comprised of instruments examining nurse related factors (e.g., education, experience), organizational factors (e.g., safety climate, staffing), and handover processes (e.g., use of technology, checklists). The majority of questions were scored using Likert scales, with response options ranging from strongly disagree to strongly agree.

Results: The overall survey response rate was 40.1%. The mean rating for handover quality was 3.42 (SD = 0.92) out of five, indicating that nurses reported handover as being slightly better than good. Using survey data, the hypothesized theoretical model was analyzed using stepwise multiple linear regression to identify variables that influence quality of nurse-to-nurse handover communication.

Conclusions: Using the factors identified in this model, it is possible to develop evidence-based interventions to improve the quality of handover communication. Understanding factors that influence ED nurse-to-nurse handover communication and developing evidence-based interventions is integral to improving patient safety, continuity of care, and staff and organizational outcomes.