Shift Change Handovers and Subsequent Interruptions

ORIGINAL ARTICLE

Shift Change Handovers and Subsequent Interruptions: Potential Impacts on Quality of Care Madeleine R. Estryn-Behar, MD, PhD, Giuliana Milanini-Magny, Architect, Elise Chaumon, MSc, He´le`ne Deslandes, MSc, Clementine Fry, MSc, Frederic Garcia, PhD, and Anne-Emilie Ravache, MSc

Objectives: Two statistical surveys in France revealed both widespread dissatisfaction about shift change handovers and the feeling of being frequently disturbed by interruptions. Shift change handovers (SCHs) are being reduced or eliminated in France to reduce staff costs. The objective of our study is to clarify the consequences of short SCHs on efficiency, team function, and quality of care. Methods: Real-time task ergonomic analysis of 29 state-registered nurses (RNs), 18 nursing aides (NAs), and 14 full-time physicians was conducted in various departments of general and university hospitals. Results: The average time available to RNs for sharing information during SCHs was 15 minutes at the beginning of the work session and 13 minutes at the end. There were, on average, 50 interruptions of activity, and these interruptions occupied 16% of the working time. Consequently, less time was available for direct care, although the number of such acts was increased. Periods for preparation of care, writing, seeking information, or equipment were very numerous. The mean number of changes of activity was very large: 260 per work session. For NAs, SCHs were similar to those for RNs at the beginning of the work session (mean = 18 minutes) but shorter at the end (10 minutes). The mean number of interruptions was 30 and caused 10.3% of the working time to be lost with 164 changes of activity. For physicians, SCHs were even shorter and, in many cases, nonexistent. The mean number of interruptions was 30 (11.4% of their working time, 153 changes of activity). Shift change handovers were mostly conducted separately for RNs, NAs, and physicians. Discussion: A better sharing of knowledge between the different healthcare workers, and especially at the beginning of the work session, could reduce interruptions and potentially improve quality of care. Key Words: real task analysis, ergonomics, team building, error risk, working conditions, nurses, physicians, efficiency, hospital (J Patient Saf 2014;10: 29Y44)

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vidence from different fields of study is emerging to support the close relationship between effective teamwork and patient safety in medicine.1,2 Errors in medicine are most frequently due to interactions of human factors, including poor teamwork and communication, interruptions and distractions, rather than to individual mistakes.3Y10 Inadequate communication between care providers or between care providers and patients/families is consistently the main root cause of sentinel events and the time of changing shift is specifically at risk. However, despite this body of knowledge, the US Joint Commission11 highlighted that for 2006, only training has been improved. The Institute of Medicine report entitled ‘‘To Err Is Human: Building a Safer Health System’’

From the Service central de Me´decine du travail de l’AP-HP, Hoˆtel-Dieu, Paris, France. Correspondence: Madeleine Estryn-Behar, MD, PhD, Estryn-Behar Ergonomie, 152 Bd Magenta 75010 Paris, France (e