Nursing handoffs and clinical judgments regarding patient risk of deterioration : a mixed-methods study
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Journal of clinical nursing
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Wiley
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- Handoff
- Clinical judgment
- Patient deterioration
- Mixed-methods research
- Nursing assessment
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Aims and objectives: To explore how change-of-shift handoffs relate to nurses’ clinical
judgments regarding patient risk of deterioration.
Background: The transfer of responsibility for patients’ care comes with an exchange of
information about their condition during change-of-shift handoff. However, it is unclear how this
exchange affects nurses’ clinical judgments regarding patient risk of deterioration.
Design: A sequential explanatory mixed-methods study reported according to the STROBE and
COREQ guidelines.
Methods: Over four months, 62 nurses from one surgical and two medical units at a single
Canadian hospital recorded their handoffs at change-of-shift. After each handoff, the two nurses
involved each rated the patient’s risk of experiencing cardiac arrest or being transferred to an
intensive care unit in the next 24 hours separately. The information shared in handoffs was
subjected to content analysis; code frequencies were contrasted per nurses’ ratings of patient risk
to identify characteristics of information that facilitated or hindered nurses’ agreement.
Results: Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a
patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93
(74.4%). These handoffs generally included information on abnormal vital signs, breathing
problems, chest pain, alteration of mental status, or neurological symptoms. However, the
quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a
clear cause, signs of delirium, and nurses’ knowledge of patient were found to affect nurses’
agreement.
Conclusions: Nurses exchanged more information regarding known indicators of deterioration in
handoffs when they judged that patients were at risk. Disagreements most often involved
incoming nurses rating patient risk as higher
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