According to existing literature, training and education of healthcare professionals to improve the quality of handovers has shown promising results and is considered an effective means to address risk factors.1-3 However, there is no consensus on the core content and instructional methods applied in this training and education.4,5
During the course of a disease, a patient is cared for by numerous healthcare professionals and in numerous settings. These include primary care, specialized outpatient care, emergency care, surgical care, intensive care and rehabilitation. The patient may move between different locations, depending on the diagnosis and care needs. During the disease, trajectory patients meet staff at the different departments working three shifts during a period of 24 hours; this introduces a safety risk for the patient in the transfers between shifts.6,7 The effectiveness and quality of the transfer of information about and responsibility for a patient between health care professionals and across settings are crucial.6 Events during handovers are related to drugs, procedures, diagnostic test follow-up, nosocomial infections and falls. These events can lead to re-hospitalization and ultimately death.6,7
Existing pre- and post-graduate health training and education programs do not cover handovers. The lack of evidence regarding the design of handover training interventions only seems to exacerbate the problem.8 Effective training of adults must be underpinned by learning theories for the instructor to be able to address the needs of the participants and thus meet the learning outcomes.9 Several studies have investigated methods of teaching in handovers, describing the method of instruction but not including the learning theory.5,10-12 The most common method of instruction used for training handovers is simulation in various forms, including formal lectures, role play, simulated patient situations, observation and feedback.5,8,12 Most commonly, the studies have shown no impact on patient safety and have primarily evaluated participant satisfaction.8 In post-graduate programs, three types of handover training interventions have been identified: formal training, workplace learning and clinical microsystem-based intervention where learning is embedded in practice.4
A preliminary search in May 2017 in the JBI Database of Systematic Reviews and Implementation Reports, CINAHL Complete, Cochrane Library, MEDLINE and Web of Science revealed three systematic reviews with a similar scope as this review.5,12,13 A systematic review published in 2016 by Lockwood aimed at determining the effectiveness of interventions designed to improve hospital-based nursing handovers revealed that no studies were suitable for a meta-analysis.13 Lockwood thus suggested a broader definition of evidence to retrieve more reviews and increase the extent of empirical data. The author also suggested that the low evidence might indicate that this aspect of nursing is understudied. At the same time, the author concluded that the list of excluded studies contradicted this perspective. The author argued that in the absence of randomized controlled trials, the question more likely was: what is current available evidence on the effectiveness of interventions designed to improve hospital-based handovers? 13 In 2011, Gordon & Findley published a systematic review including 10 studies on training of interventions to improve handovers among undergraduate or postgraduate doctors or nurses.5 The methods of instruction used in the included studies were exercise-based simulations, role-play, group discussions or lectures focusing on adverse events and patient safety. The review was based on literature published before June 2010 and only included training of interventions among inpatients. The reviewers found the included studies had a poor methodological quality.5 In 2013, Masterson et al. published a systematic review including studies on training interventions in healthcare concerning handovers. The review included 12 English language studies published between 1990 and 2009. The authors of the review concluded that most literature within the field simply represented a mnemonic or checklist for handovers without describing training interventions.12 The studies were divided into two categories: i) studies where the primary outcome was a change in handover skills or efficiency based on personal perceptions or external evaluations, ii)studies revealing a secondary outcome such as identification of strengths or weaknesses in current handover skills or identification of healthcare staff satisfaction. Notably, none of the included studies reported changes in patient outcomes after a training intervention on handover skills. However, the results indicated that training handovers enhanced the participants’ confidence in carrying out the skill, and that some training interventions might improve handover communication.12 The majority of studies showing improvements had defined goals for handovers or a summary tool targeted at the work environment, used simulation under supervision, direct feedback and the opportunity to practice learned skills.12 None of the studies identified the underlying mechanisms of the handover interventions. These three reviews on field training interventions regarding handovers covered the literature up to 2010 and provided a scattered, complex and heterogeneous picture of the field.
With the current scoping review, we will provide an updated and broader review to include recent literature within this field. In addition, we wish to identify not only education models but also theories underpinning the models. Inspired by Lockwood, we will implement a broader definition of evidence to provide empirical data and propose a scoping review to map existing evidence with in a broad field of training interventions on handovers.
To develop contemporary and sound interventions for handover training we need knowledge about the effectiveness of interventions. In addition, we need a theoretical understanding of how interventions work and lead to change in order to identify and strengthen weak links in the causal chain.14 All theories, principles, components or other methodological options will be important contributions to a future design of a handover training intervention.
The scoping review will follow the JBI scoping review methodology.15
This scoping review will consider studies that include healthcare professionals from any healthcare profession including nurses, physicians and residents, who are involved in the handover of patient information to a fellow professional.
The concepts examined by this scoping review are training interventions on handover skills in the provision of education of healthcare professionals. This includes formal and informal training interventions and includes but is not limited to literature that describes theories, teaching methods, content, evaluation, methods and outcomes of the training intervention. Handover is understood as “the transfer of information about and responsibility for a patient between health care professionals and settings”.2 (p.84)
This scoping review will consider studies that have been conducted in healthcare settings. Studies aimed at any setting including but not limited to workplace settings will be considered. Studies conducted in any geographical area will be considered.
This scoping review will consider both experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion.
Qualitative studies will also be considered that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research.
Text and opinion papers will also be considered for inclusion in this scoping review. Studies published in English, Swedish, Norwegian and Danish will be considered for inclusion in this review. No date limits will be applied to the searches: each search will be performed from the beginning date of the databases to the present.
The search strategy will aim to find both published and unpublished studies. An initial limited search of PubMed/MEDLINE and CINAHL has been undertaken to identify articles on this topic, followed by analysis of the text words contained in the titles and abstracts, and of the index terms used to describe these articles. This informed the development of a search strategy including identified keywords and index terms that will be tailored for each information source. A preliminary search strategy for PubMed/MEDLINE is detailed in Appendix I. The reference list of all included studies will be screened for additional studies.
The databases to be searched for published studies include: CINAHL Complete/EBSCO, PubMed/MEDLINE, Embase, ERIC/EBSCO, PsycINFO/EBSCO, Web of Science, Google Scholar, Idunn.no, bibliotek.dk and SweMed+.
The search for unpublished studies will include Open Grey, Current Controlled Trials, MedNar, ClinicalTrials.gov. and Cos Conference Papers Index.
Results will be extracted from papers included in the scoping review using the draft data extraction tool listed in Appendix II by two independent reviewers. The data extraction tool has been developed by the authors in order to cover the research questions. The data extracted will include specific details about the population, concept, context and type of study. In the event that we find educational interventions on handovers in different types of populations, we will consider undertaking a sub analysis. In addition, the data extracted will include specific details about the content of the educational interventions, underpinning theory, teaching methods, level of evaluation/outcome and evaluation tool of significance to the review question and specific objectives. To identify and present any reported outcomes of educational interventions, the Kirkpatrick model has been integrated into the charting table.16 The Kirkpatrick model describes four levels of outcomes that can be assessed when studying an educational intervention: i) to what degree participants react favorably to the training, ii) to what degree participants acquire the intended knowledge, skills, attitudes, confidence and commitment, iii) to what degree participants apply what they learn during training when they are back on the job, and iv) to what degree targeted outcomes occur as a result of the training event.16 Disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Authors of papers will be contacted to request missing or additional data where required. The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included study. Modifications will be detailed in the full scoping review report.
The extracted data will be presented in diagrammatic form in a manner that aligns with the objective and scope of this scoping review. The charts will resemble the extraction tool (Appendix II) and report on distribution of studies by author(s), year of publication, countries of origin, type of study, population, content of educational intervention, underpinning learning theories, teaching methods, level of evaluation outcome and evaluation tool. This may be further refined at the review stage and the charting tables updated accordingly. A narrative summary will accompany the charted results and will describe how the results relate to the review scope and objectives.
Appendix I: Search strategy for MEDLINE/PubMed
Full electronic preliminary search for MEDLINE
Search string including Free text words and MeSH.
Appendix II: Draft study details, characteristics, and results extraction instrument
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