Teaching communication skills for handover: perioperative specialist practitioners

Abstract

Context and setting Effective handover skills are essential for the efficient and accurate transmission of patient information, but there is little evidence that these skills are explicitly taught. Recent interest in handover skills is associated with: reduced working time for junior doctors (which results in more frequent handovers); identifying factors that affect patient safety; emphasis on team approaches to the delivery of care, and educative benefits for participants. Our team has developed a new surgical role, the perioperative specialist practitioner (PSP). The PSP delivers care at either side of the operative period and routinely transmits patient information to consultant surgeons and anaesthetists. Our innovative training programme provided an opportunity to pilot a session on handover skills in the context of this specific role. Why the idea was necessary Although widely agreed to be essential, effective handover skills may not develop spontaneously and there is a clear need for structured training. There is a growing literature on what is required, which includes planning, leadership, focused presentation and discussion of information. Obstacles include insufficient time, lack of preparation, distracted participants, incomplete information and imprecise role function. Key verbal skills include clarity of speech and the ability to structure information, emphasise key points, summarise and separate fact from judgement. Non-verbal skills include using supportive written documents (e.g. results of clinical tests), eye contact, posture and hand gestures. What was done We developed a 2-hour teaching intervention on handover presentation skills (HPSs), using principles of adult learning. Learning outcomes for PSPs included the ability to identify and apply effective presentation skills to handovers, develop awareness of their strengths and weaknesses, and identify ways to improve handover skills. Educational methods included discussion of theoretical materials, role-play with videotape review and written reflections. Using clinical scenarios, each PSP rotated through 3 roles, as him or herself, as an observer and as a consultant (surgeon or anaesthetist). In their own role, PSPs made a handover based on a patient they had previously assessed, while the consultant role was played with varying levels of challenge (e.g. asking questions in an aggressive manner, being distracted). Each 3-min handover was preceded by 5 mins of preparation and followed by 12 mins of feedback. The observer facilitated feedback and managed the process of videotape review. Evaluation of results and impact A total of 14 PSPs evaluated the HPS intervention in terms of learning outcomes achieved and the perceived value of the learning methods. Between 8 and 11 PSPs completely achieved each learning outcome. All thought the session guide was valuable in supporting learning, while the discussion activities and written reflections were at least partially valued. Free text comments revealed that handovers based on real patient assessments were perceived to have grounded the role-play in reality. Although some PSPs experienced difficulties in playing the consultant role, the exercise helped them appreciate different perspectives and the need to adapt information according to circumstances. Through written reflections we gained insight into what happens in practice, enabling more precise articulation of effective content and skills. This innovation lies in content rather than educational methods and is likely to be relevant to the training of all health care professionals.