Clinical handover in acute psychiatric and community mental health settings

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Abstract
Accessible summary: This study collected a snapshot of current handover practice in mental health settings from doctors, nurses, community and allied health staff. The handover of care is a very important process as breakdown in communication during shift changes or when a patient is transferred from one place to another is one of the leading causes of adverse events and failure of care or services. Structuring the content of the verbal component of handover and documenting the handover may make measurable improvements to the effectiveness of clinical handovers. Sometimes negative statements are expressed about a patient during handover. This should be avoided as negative labelling and judgement of a patient or illness can have serious consequences for patient care, especially when this information, if passed on, could prejudice the oncoming shift. The inclusion of prompts or simulation models to recognize and escalate patients that are deteriorating in their physical condition or mental state may improve patient outcomes by prompting action to avert adverse events. This study collected an area‐wide snapshot of current handover practice in psychiatric settings which included acute care units and community mental health centres. The study was conducted in two stages. Firstly, a questionnaire was sent to all clinical mental health staff within an area‐wide health service regarding normal handover procedures and processes. The second part of the study used non‐participant observers to evaluate actual handovers in inpatient and community settings. Of the 1125 surveys distributed in stage one, 380 (34%) were returned completed. Of the 40 handovers observed in stage two in which 637 patients were discussed, 40% included at least one consultant psychiatrist or registrar as a participant. Almost all the handovers were completed face‐to‐face in a specific location with a set time and duration. Eighty‐six per cent of respondents reported that deteriorating patients were escalated for rapid response. The results of the survey and structured observations support the issues emerging from the literature from medical, surgical and clinical team handovers. Additionally, the issue of identifiers for deterioration of a psychiatric patient emerged as an area worthy of further investigation and incorporation into clinical handover education and training for psychiatric services.

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