Generic Handover Investigation (GHandI)

Handover of responsibility for a system from one individual or team to another makes a vital contribution to the safety and effectiveness of the work. Poor handovers have been identified as contributory causal factors in high profile disasters such as the Piper Alpha Disaster. Recently, handovers in the healthcare sector have come under scrutiny with the implementation in 2004 of the European Working Time Directive, which resulted in the introduction of shift working for junior hospital doctors in order to reduce their working hours. This saw a corresponding increase in the frequency of shift changeovers and made effective clinical handover all the more imperative. Yet current practice is highly variable: it varies from ward to ward and hospital to hospital. Handovers are often impromptu, informal and supported by ad hoc artefacts such as paper-based notes. This is a reflection of the fact that there has been surprisingly little research into this crucial aspect of patient safety.While there have been small-scale studies of clinical handover in specific settings, including our own study of a paediatric ward on the ACE project, there is a lack of basic research. We will address this shortcoming in the GHandI project with an extensive investigation of handover as it is only by achieving a clear understanding of the 'work' that handover accomplishes that we will be able to improve the practice. For example, there is evidence that handover contributes to patient safety by accomplishing work other than the immediate transfer of responsibility for care of the patient. It is within this context that the current proposal is situated, the overall aim of which is to conduct a detailed investigation of clinical handover and its contribution to patient safety by developing and evaluating a generic theoretical model of handover and deriving detailed recommendations and prototypes for innovative handover support technology. This is decomposed into the following objectives:1. To develop a generic model of clinical handover from a socio-technical system perspective that will capture its many commonalities and variations. This will be achieved at both practical and theoretical levels.2. To design and evaluate prototypes for innovative handover support technologies, integrating results from 1 and 3.3. To investigate the role of simple codes and graphic languages in improving communication and reducing ambiguity in information resources used in clinical handover.4. To investigate the nature of an effective handover and determine how this can be measured.In order to ground the modelling and design activities in a genuine understanding of the work, we will undertake a detailed study of clinical handover in a range of very different settings. With the support of our collaborators, we plan to study handovers in ten clinical settings, ranging from ambulance 'retrieval' services to inter-specialty transfers to shift handovers in paediatric intensive care units. This in itself will be an important contribution from GHandI.The outcomes of this research will be of direct benefit to the healthcare sector, both the field study settings and the NHS more generally. They will benefit from an improved understanding of handover, from guidance on effective practice and from the prototype handover technologies. Improved handovers will enhance patient safety, and therefore the quality of life, and improved working practices will be of benefit to clinical staff. The results, particularly the modelling work, will also be of relevance to other critical domains where handovers between operators make an important contribution to the safety and effectiveness of the work, e.g. the continuous process industries. Finally, the HCI and CSCW academic communities will benefit from the theoretical modelling work, from the detailed study of this particular form of collaborative work and from the investigation of graphical communication tools.