Clinical handover, the transfer of information about and responsibility for a patient from one healthcare professional to another, has become an important area of research aimed at improving healthcare.1
Deficiencies and process failures in communication during handover are at the root of many patient safety problems. While much of the research has focused on handovers in a clinical setting, here we discuss handover practices between organisations, particularly transfer of information on coordination of care after discharge.2
Poor coordination of care across settings may result in discontinuity of care, confusion and patient harm, and has been identified as a factor in re-hospitalisations that are costly, potentially harmful and often avoidable.3
Since hospital readmissions adversely affect patients, payers and providers, identifying the solution requires the involvement of stakeholders across the patient care continuum.4
Studies have shown that a significant proportion of patients (ranging from 33% in New Zealand to 60% in Germany) report a suboptimal discharge experience from hospital.6
Healthcare professionals’ perceptions of the quality of handovers at hospital discharge echo patients’ comments about problems with quality and continuity of care.7
Various international and national bodies have supported research on and the implementation of patient handover practices. For example, the WHO has encouraged research and action in this field as part of their initial High 5s programme, focusing on medication accuracy during transitions of care and on communication processes during patient care handovers.9
The Australian Commission on Safety and Quality in Health Care10
and the British National Patient Safety Agency11
have published comprehensive guides on handover improvement.
In Catalonia, Spain, research has investigated patients’ and healthcare professionals’ perspectives on factors that have a negative impact on care coordination.12
These findings mirror reports in the literature that identify context-specific factors (such as local cultures, professional values and referral mechanisms) and wider organisational determinants (such as the organisation of services, payment and financing systems) that mediate communication processes and impact on the continuity of care.
While research into handovers has addressed different clinical conditions and organisational settings,14–17
the role and engagement of patients in the handover process and whether some patients or patient groups may be differentially at risk for poor quality of care during handovers with potential associated risks have not been studied to date. Previous studies have demonstrated deficiencies in handovers at the primary–secondary care interface, including insufficient attention to informational needs, emotional stress, social problems, untimely follow-up care and conflicting medication regimes.13
The frequency of problems appears to be associated with patient characteristics such as age, cognitive function and limited social networks, and may lead to suboptimal quality of care, in particular to unnecessary readmissions.18
A systematic review has addressed interventions to improve discharge from hospital to home for elderly patients, who are clearly at risk because of declining cognitive function and often living alone.20
However , studies have primarily focused on the effectiveness of supportive discharge programmes and not on the factors through which such patients are potentially exposed to harm. The specific roles of patients and their family members in the handover process are under-studied and relevant to efforts to improve patient safety.
Previous research has shown that patients of lower socio-economic status and/or with limited health literacy are less engaged in the medical encounter, have less understanding of information provided, have poorer self-management after follow-up and have higher utilisation of services.21–23
This might also have important implications for clinicians caring for these patients, in particular with regard to components of patient handovers such as history taking, transmitting information and motivational counselling for self-management or follow-up care.
We selected patients with limited language comprehension or health literacy, or a lack of social resources or support, as ‘vulnerable’ patients who are likely to be at greater risk during inter-organisational handovers. The objective of our study was to explore the role and engagement of patients in the handover process with a particular focus on these vulnerable patients. We collected information on how these patients experience their handovers at discharge from hospital, the characteristics of their contribution to the handover (either active or passive), and the quality and safety implications for these patients.