Our global survey of healthcare practitioners reinforces the risk of handover

Today we published the results of our global survey of healthcare practitioners, asking their opinions on the safety of handover. The survey was conducted with authors from Newham University Hospital in London, HCA International and Bristol University Medical School. 

While patient safety in operating theatres has been a recognised problem for many years – ever since the publication of the original checklist article in the New England Journal of Medicine – handover as a common clinical process has not been studied so widely.

We undertook the survey because we believed that handover in healthcare was an under-appreciated problem for patient safety. And according to the 438 responses to the survey – from all parts of the world, from all levels of seniority and from many different clinical groups – we were right.

Our research backs up and contributes to evidence about problems with patient safety in handover.

What we learned about handover

1.     Handover causes frequent errors and patient safety incidents

Errors in handover occur weekly or daily according to 12% of our respondents. A third of them said this happened at least once a month. This is sobering news as a patient: your own critical information is being regularly mangled. 

2.     Handover errors can cause serious harm to patients

Nearly 10% of our respondents had witnessed severe harm and 30% moderate harm (or worse) because of handover error. Just to be clear: severe harm is either death or otherwise life changing. Moderate harm will keep you in hospital or inflict noticeable suffering.

3.     Most people think they are better than average at handover

Despite this, most practitioners don’t see their own practise of handover as being well performed – on average they give themselves 4 out of 5 stars. We think this is a bit like a sense of humour – or driving ability – most people think they outperform the average. We also think this indicates a dangerous degree of complacency.

4.     The longer you’ve been around, the scarier handover appears 

One stand-out feature of the data, however, was the very strong correlation between how risky practitioners view handover and their seniority. In other words, the more handovers you see, the more you worry about patient safety. Juniors appear blissfully unconcerned – which is a shame, because they are responsible for a lot of handover activity.

5.     Different types of handovers have a similar safety profile

We asked about three types of handovers: peer-to-peer (individual to individual), internal referrals (team to team) and discharges/transfers (institution to institution). Whichever type we looked at, we found no difference in the way that people thought about these different types.

6.     The safety of handover is a problem all over the world 

Our survey had representatives from 26 different countries and from all major professional groups as well as managers. We also had good representation from different settings including hospitals and community practitioners. We found very similar responses from each group no matter their location. 

7.     Most practitioners use manual or informal systems to support handover

One of the most worrying findings is that most handover takes place using a mishmash of different support systems. 35% are still using hand-written notes. 21% are using office documents such as Word and Excel. 10% use manually written whiteboards and a full 15% are using unofficial messaging apps like WhatsApp.

8.     EPR systems are not up to the job of supporting handover

Worryingly, given the amount of spending on Electronic Patient Record systems (EPRs) in the last decade – only a quarter of respondents relied on such systems without recourse to other, manual or unofficial systems.

It is worth pausing here and thinking what a similar answer might look like in another high-risk industry. “Oh yes, our dangerous chemical plant has a big expensive computer for managing all these difficult processes – but we don’t really use it because it wasn’t designed properly”.

9.     Staff need more training, and we need more time

Half of all respondents said they need either more time to do handover and more than a quarter need more physical space in which to do it.

10.  Healthcare leaders want better electronic systems

Healthcare leaders reflect the same concerns as staff, but they specifically also want more access to patient information and better electronic systems. 

This survey paints a picture of an industry that is failing to take sufficiently seriously the dangers of arguably the most common, and one of the most important, processes.

Handover is the transfer of responsibility and crucial patient information between practitioners and teams. We do ourselves and our patients no favours if we fail to take the patient safety implications seriously.