Fiona Geddes

An Analysis of Clinical Handover Miscommunication Using a Language and Social Psychology Approach

Clinical handover is a key communication event in patient care and a major contributing factor in adverse events in hospitals. Current research on handover emphasizes communication skills training. We investigate the intergroup context and systemic factors of the hospital environment that also affect handover. We explore the responses of 707 health professionals about handover practice. We invoke Coupland and colleagues’ integrative model of “miscommunication” to interpret these. Results support the model. Responses reflect a lack of communication competency, intergroup group relations, and the hidden ideology of the health care system. Health professionals in hospitals are often unaware of the socio-structural element in health care and so cannot bring about cultural change. We suggest that clinicians work with communication and interdisciplinary scholars to bring about system improvement.

Communication failures during clinical handovers lead to a poor patient outcome: Lessons from a case report.

In the emergency department, communication failures occur in clinical handover due to the urgent, changing and unpredictable nature of care provision. We present a case report of a female patient who was assaulted, and identify how various factors interacted to produce communication failures at multiple clinical handovers, leading to a poor patient outcome. Several handovers created many communication failures at diverse time points. The bedside medical handover produced misunderstandings during verbal exchange of information between emergency department consultants and junior doctors, and there was miscommunication involving plastic registrars. There was a failure in adequately informing the general practitioner and the patient relating to follow-up care after discharge. Deficiencies of communication occurred with conveying changes in an investigative report. Communication could be improved by dividing the conduct of handover in a quiet room and at the bedside, ensuring multiple sources of information are used and encouraging role-modelling behaviours for junior clinicians.