Internal and External Communication
1-a internal communication you would recommend to ensure that hand over process in hospital wards is made efficiently. Typically handover occurs at two levels. The first is the generic handover, completed by the whole team. This handover is often a summary in nature, with only generic client information included. This handover generally does not allow for provision of detailed profession specific information. The handover is typically provided to a central location, namely the receiving hospital or General Practitioner, with copies provided to relevant health services.
Breakdowns occur when this handover report is not distributed beyond the primary receiving service or professional. Consequently the AHP may not be aware of the handover, and the client will then fail to receive the required service. The second level of handover involves profession specific handover, where clinical handover is provided between individual health professionals at the referring and receiving site. There are limited standard templates or formats for this type of handover.
However, Department of Health (DoH) dietitians have recently collaborated to establish a standard client transfer summary sheet, which includes specific information when handing over within the same discipline. 5 A similar approach may be useful for other allied health professions OBJECTIVE: To describe and evaluate the PACT (Patient assessment, Assertive communication, Continuum of care, Teamwork with trust) Project, aimed at improving communication between hospital staff at handover. DESIGN, SETTING AND PARTICIPANTS: The PACT Project was conducted between April and December 2008 at a medium-sized private hospital in Victoria.
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Action research was used to implement and monitor the project, with seven nurses acting as a critical reference group. Two communication tools were developed to standardise and facilitate shift-to-shift and nurse-to-doctor communication. Both tools used SBAR (situation, background, assessment, recommendation) principles. All nurses attended workshops on assertive communication strategies and focused clinical assessment of the deteriorating patient. Questionnaires were distributed to nurses and doctors at baseline, and post-implementation questionnaires and qualitative data were collected from nurses immediately after the project.
MAIN OUTCOME MEASURES: Nurses' opinions of improvement in structure and content of handover; nurses' confidence in their communication skills. RESULTS: At baseline, 85% of nurses believed communication needed improvement. After implementation, 68% of nurses believed handover had improved and 80% felt more confident when communicating with doctors. CONCLUSION: Early evidence supports the use of standardised communication tools for handover, together with specific training in assertive communication and patient assessment. Long-term evaluation of patient outcomes is needed.
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