Using Discourse Analysis to Inform Better Nursing Handover Communication in a Bilingual Hong Kong Hospital

Clinical handover – the transfer between clinicians of responsibility and accountability for patients and their care – is a pivotal, high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication – including incomplete and unstructured clinical handovers – as a major contributing factor.
In this paper, we detail the research and the Better Handover training we have now delivered to nurses at a bilingual hospital in Hong Kong. We first describe four identified areas where changes to handover practice are likely to improve patient safety and continuity of care: 1) Handovers would be safer and more consistent if nurses followed an agreed and systematic structure to sequence their presentation of handover information; 2) All incoming nurses need to actively engage with the handover by interacting to check, clarify and confirm information; 3) Outgoing nurses need to ensure the explicit transfer of responsibility by requiring confirmation and readback of key information, including instructions for the patient’s ongoing care; 4) All nurses present need access to the relevant documentation at the time of the handover, and need to be trained to use the verbal handover to add value (not simply repeat) to written documentation.
We then explain how we developed our educational module in response to the communication problems we identified in a sample of audio and video recorded handovers collected. After briefly reviewing the interactional and informational strategies we recommend, we conclude by highlighting the differences between how the nurses conducted the handovers before and after the training.