Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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Key objectives
The objectives of the European HANDOVER research collaborative were to:
a) identify the barriers and facilitators in the medical, social and technological contexts
in which patient handover takes place;
b) identify key strategies and tactics for reducing readmissions that could be applied
across Europe;
c) understand actionable strategies for engaging community organizations across the
continuum of care;
d) strengthen patient involvement and understanding of their care;
e) develop and assess tools and training programmes for implementing patient
handover training; and
f ) assess the cost–effectiveness of handover interventions.
The principles of the HANDOVER study
1 . A systematic qualitative multimodel study using content analysis was performed
using grounded theory of hospital and primary care physicians and nurses, patients
and caregivers in five countries. One hundred and ninety-two individual interviews
and 26 focus group interviews were conducted in five EU countries with patients or
caregivers, hospital physicians, hospital nurses, GPs and community nurses.
2 . Clinical foci: to properly address the health care continuum, several clinical
conditions which represent the entire chain of care (primary care – referral –
hospital – discharge – aftercare by primary care physician) were identified. These
include chronic illnesses such as diabetes, heart disease, asthma, chronic obstructive
pulmonary disease and polypharmacy (>6 drugs per patient).
3 . Patient groups: the HANDOVER project included attention to the patients and
their carers, especially in terms of care of older patients (60+ years), and handovers
of patients with multiple conditions. In addition, attention was paid to minority
groups such as people with communication problems due to language barriers
and/or hearing/sight impairments. For example, the project in Spain focused on
communication challenges with non-Spanish-speaking minorities and how to
address their crossborder care needs.
4 . Microsystems: HANDOVER used the clinical microsystem at the primary
care−hospital interface as the unit of analysis.
5 . Applied quality improvement methods: the prospective, multimodel study was
conducted applying sophisticated quality improvement tools such as process maps,
surveys, interviews, focus groups, observations, artefact analyses and Ishikawa
diagrams to directly assess patient handovers and shadow physicians and nurses
providing care following patient handovers.
What has been learned as a result of the initiative?
While the prevailing handover practices differ across Europe, many of the identified
referral and discharge barriers and facilitators appear to be similar in the different
countries and settings. The key themes underpinning the barriers and facilitators for
patient discharge and referrals that emerged from the analysis include: communication
content, process, tools; attitudes; organizational factors; community resources; patient
awareness; and patient empowerment.