Communication is an essential facet of medical training. Poor communication is the primary cause in most of complaints up against the National Health Service (NHS) (Pincock S. , 2004). Communication is particularly important at handover to ensure continuity of appropriate health care and to ensure safe practices of patients. The added constraint in medical handovers is the fact the process is limited by time. The SBAR (Situation, Qualifications, Assessment and Recommendation) tool is supposed for effective transfer of information between medical researchers in a concise, factual and standardised structure. This short article assesses the value of instructing communication in medical education with particular focus on handover, the available literature on SBAR and the author's view on SBAR as a communication tool for medical students and trainee doctors.
Introduction
Communication lies in the centre of good medical practice. The General Medical Council has mandated the need for good communication skills to ensure that patients are maintained informed of their condition, improvement, investigations, treatment and improvement. Good communication skills are also necessary to ensure continuity of patient care and to ensure patient safety. The intro of the shift system has made effective communication more important (General Medical Council).
Poor communication is the primary cause for the majority of problems in the Country wide Health Service. Poor communication between medical researchers, failure to have up to date consent and improper handling of problems are the major reasons and effective communication would have reduced the disputes and issues (Pincock S. , 2004).
Teaching communication to medical students in UK medical schools
The UK council of communication skills in undergraduate medical education was established in 2005 with the purpose of raising awareness, to boost current teaching, to boost and also to develop consensus on the communication training provided to medical students (THE UNITED KINGDOM council of communication skills in undergraduate medical education). This in the author's opinion represents a significant step towards acknowledgement of the need for training medical students in communication skills training. As well as the benefits which better communication has in relation to patient safe practices and reducing problems, research has suggested that coaching communication skills to medical students better their overall performance (Smith, Hanson, & Tewskbury, 2007).
The medical handover: communication is vital
The National patient safety firm (NPSA), London has identified handover as "The transfer of professional responsibility and accountability for some or all areas of care for an individual, or group of patients, to another person or professional group over a temporary or permanent basis" (National Patient Safety firm, 2007).
Medical handover is one of the main procedures and has the potential for triggering errors and damage if done incorrectly. Additionally it is a very recurrent incident with the introduction of the transfer system of working. The General Medical Council in addition has recognised the value of your good handover and explained that "'keep fellow workers up to date when writing the care and attention of patients" (Standard Medical Council).
Benefits of an good handover
Good handover has many perks both for the doctor and the patient. For the doctor the handover period may be used to improve communication skills and can be used to instruct clinical medicine. A good handover also makes working less stressful as the doctors on the transfer have will have good knowledge about the patients and their management programs. The British Medical Association in addition has opined that clear communication at handover will protect the doctor against blame for mistakes (English Medical Connection, 2004).
Good handover also benefits the patient by providing continuity of attention, providing safety, decreasing repetition and in providing better service satisfaction. There are several critical incidents of patient security being compromised due to insufficient clear handover between teams (British Medical Association, 2004).
Constraints to good handover
There are several constraints to a detailed handover. Within the author's own experience of handover in an intensive good care area, enough time allocated for handover is often inadequate to handover all details of patient care. However the day handover is led by the specialist on call and attended by way of a multidisciplinary team relating to the physiotherapist and the in control nurse, evening handover often involves only the junior doctors on call. Because of the complicated problems which most patients on intense good care have, the handover often extends beyond the allocated time of 30 minutes. Which means that the doctors who are departing cannot do so on time and those who are starting cannot get on using their duties promptly; both these circumstances lead to a feeling of dissatisfaction with the work. The handover location varies from the patients' bedside to the doctors' office and for that reason lacks uniformity and continuity. Further the handover can be interrupted by non-emergency calls from various areas of the hospital. On some situations handover is considered by one team while the other team is establishing the ventilator which results within an unsatisfactory handover.
Because of the existence of employees from paediatric, extensive care, anaesthetic, medical and other allied health back again grounds at the morning hours handover, there are significant variations in the style, span and the value which different people place on different aspects of the handover. Also the experience levels of the several trainees are variable and they change in the capability to highlight important aspects of patient good care and in their potential to summarise the progress of a patient in a concise way.
Need for a structure to handover
One of the criticisms of handover among medical professionals is the "hint and expect" deal with where one individual suggestions at what might be occurring without offering any specific details and desires to obtain a specific response or action (Featherston, 2005).
The handover process needs to be streamlined to allow transfer of a sizable amount of information regarding very sick and tired patients with complicated needs in a time limited manner. Which means that there is a need for a system of handover which is set up, complete, relevant and concise to ensure uniformity of the procedure and also to ensure continuity of patient care.
Literature of handover in other hospital settings
A research of handover of scientific attention from ambulance crew to the crisis department personnel exhibited that there were concerns regarding the quality and quantity of handover, the personnel conception of handover and staff education. This analysis also identified the need for a standardised handover process which would allow smooth transfer of patient care and provide chance for the getting team to examine and prioritise their work (Bost, Crilly, & Wallis, 2010). The English Medical Connection (Uk Medical Relationship, 2004), THE OVERALL Medical (General Medical Council) and the National patient safety company (Country wide Patient Safety agency, 2007) have all emphasised the need to develop a system of effective handover.
SBAR
SBAR (Situation, track record, assessment, suggestion) is a communication technique that delivers a composition for communication between healthcare pros. SBAR originated by Dr. Leonard and acquaintances in 2006. It is great for handover from nurse to nurse, doctor to doctor and doctor to nurse. SBAR enables healthcare specialists to connect in a particular framework.
When put on handover communication, S means situation which is a short explanation of the issue, its severity so when it began. B stands for pertinent background talking about the admission prognosis, results of investigations and other scientific information. Information on current resuscitation status could also be included in this. A means the handing over team' examination of the individual position and R means recommendation how the individual should be been able. Recommendation can also be used to revise the team receiving the handover how quickly a patient needs to be observed and this can help them prioritise their responsibilities.
Literature on use of SBAR
SBAR is relatively new and there have only been a few studies looking into its effect on communication and patient safe practices. One study confirmed that staff found SBAR tool helpful in team and specific communication. Because of this the analysis team using SBAR perceived a noticable difference in patient protection culture. The study group also exhibited an improvement in reporting of occurrences and near misses in the team and in the establishment where analysis was done (Velji, Baker, & Fancott, 2008).
Another analysis found fewer missed information at handover and suggested that this improved patient safeness. The authors of the study opined that was the consequence of information transfer in a concise and organised format (Haig & Sutton, 2006).
Other studies have reported blended results. A study from Tx found no or slightly negative effect on the nurse self confidence while speaking with physicians, basic safety on the machine and satisfaction with focusing on the machine. However there is some gain on communication openness and in reviews about problems. It must be observed that this study was predicated on an evaluation of key final result measures carrying out a four hour class room training on SBAR which the authors themselves illustrate as limited. The writers have advised caution regarding the common use of SBAR regardless of the lack of evidence of its effectiveness (Carroll, 2006).
The SBAR collaborative communication data based practice research (SBAR EBP) showed that use of SBAR resulted in transfer of data, knowledge and specialized medical skills. The second outcome from this study was the benefits known in communication, teamwork and security environment. However as the authors of this review take note, there are no studies up to now which show benefits in patient effects or patient cooperation. This research also mentioned that no medical doctors participated in the SBAR collaborative-communication education. The writers also mentioned that physicians noticed that SBAR teaching was meant for nurses and that doctors need not attend nursing classes (Beckett & Kipnis, 2009).
Summary of the data and opinion
It is the author's view that SBAR as an instrument for handover will become a even model around which personnel can speak at handover. It also encourages critical considering around the time of handover. It allows precise, complete and concise transfer of information at handover. That is more likely to improve better team working and eventually improve patient safeness. However there are likely to be impediments to the implementation of SBAR for handover. Doctors especially at more senior levels will probably ask for research regarding the positive effects of SBAR on patient security before they support its execution over a wider basis. Therefore there is a need for large well designed studies to demonstrate a significant benefit from use of SBAR not only on the staff perceptions and communication skills but also on patient safeness.
Teaching SBAR to medical students and trainee doctors
It is author's opinion that communication models on medical handover should be educated from medical college days. The move from pupil to doctor is huge and medical students should learn to really have the skills to make this transition as even as you can. There is bound literature available on teaching SBAR to medical students. One analysis using a simulated clinical setting found that medical students who went through 40 minute training on the improved SBAR model (ISBAR), performed significantly much better than controls on the content and quality global rating credit score (Marshall, Harrison, & Flanagan, 2009). There exists literature available on instructing SBAR to medical students and the benefits it has had (Thomas, E, & Johnson, 2009), (Lumber, 2008) (Kesten & Karen, 2011). The uptake of SBAR appears to be more robust amidst the nursing pros than the doctors. As the uptake of SBAR boosts it would become more important that doctors also become experienced in the use of SBAR as a style of communication. Therefore there is a need for both doctors in training and medical students to learn in the utilization of SBAR.
Recommendations on training in SBAR for use in medical handover
Based on the knowledge of handover within an intensive care setting up and after review of the above literature, it is the author's view that systems for handover desire a radical overhaul to ensure patient basic safety and also to improve communication within teams. Among the steps is a structure to the handover improvement in the form of the SBAR. As an initial step junior doctors need training in the utilization of SBAR for handover. Before the intervention, a baseline examination of communication skills using a proper tool would help screen progress. This is in the form of an interactive small group discourse where the process of SBAR is completely explored. It is also important to provide the available research on SBAR and exactly how it can improve communication results and possibly patient final results. A simulation exercise by the end of the discourse will also help doctors understand the abilities needed. This teaching session must be done on several days and nights and sometimes and location which assist in and encourage junior doctor involvement. The aim is to ensure that the junior doctors in the particular unit or organization have the possibility to attend this time.
A separate session must be organised for the consultants who will be supervising the junior doctors as they use SBAR. Consultants will need to play a significant role in enforcing the use of the tool and to monitor the potency of this tool. Consultant guidance is essential to support the handover process using SBAR and also to facilitate the involvement of multidisciplinary clubs at the handover.
Handover predicated on SBAR also needs to be accompanied by solid changes like having a passionate time and place for the day and evening handovers, ensuring the handover is not interrupted for non-emergency reasons also to ensure the availability of electronic resources which can help in handover.
After a pre-defined period where SBAR process is carried out, there has to be an analysis of the result SBAR has had on the handover process specifically and communication generally. Proof improvement in the handover process will encourage personnel to boost further on the skills. The process of execution should be active and continuous until the process becomes a part of the working culture.
Summary and conclusions
Inadequate handover poses significant risks to the workers involved, their business and their patients. Handover therefore needs to be complete, specific, concise and set up to allow effective copy of information. Usage of SBAR provides a framework to the handover improvement. There is information that use of SBAR has positive benefits on team working and communication and it is likely that this has an optimistic effect on patient safety. The procedure of execution of SBAR calls for training of personnel with guidance and mentoring from mature participants of the team. Gleam need to carry out well designed studies to assess the impact of SBAR on medical handover and to determine potential advantages to patient safety.
