MASALAH

 Poor communication and lack of structured format are contributing factors in adverse
incidents where patient care is put at risk. (Vinu & Kane, 2016)

 Clinical handover is the transfer of professional responsibility and accountability for

some or all aspects of care for a patient, or a group of patients, to another person or
professional group on a temporary or permanent basis. Handover is fundamental to
patient care as planned care is continued between care providers. The communication
task in handover is considered a high-risk situation for patient safety, and the danger of
discontinuity of care, adverse events and legal claims of malpractice are identified as
problems resulting from communication failures during handover. Indeed, the primary
cause of over 70% of sentinel events is attributed to communication breakdowns. (Vinu
& Kane, 2016)

 Inadequate clinical handover is recognised risk to patient safety. Poor communication at

clinical handover is a contributing factor in adverse incidents where patient safety is put
at risk. Communication errors are reported to be almost twice as common a cause of
adverse events as those due to inadequate skills of practitioners. (Vinu & Kane, 2016)

 Handover offers an occasion to reflect on the previous shift and it needs to be focused.
Shift handover has also been identified as an occasion where information accuracy can
decline. Poor clinical handover communication or inadequate transfer of information can
have significant consequences related to safety, quality in health care and will be the
vital contributor to adverse events. Ineffective handovers of patient information has
been associated with delays in treatment that can have detrimental effects in seriously ill
patients and adverse medical events for patients, and ineffective handover also has
impact on efficiency and effectiveness. (Vinu & Kane, 2016)

 Nursing change of shift handover is the vital moment of nurse-to-nurse communication,

enabling transfer of professional responsibility and exchange of patient information,
thereby improving accountability. The handover promotes continuity of care by
transferring the care to a competent, qualified nurse so as to meet the therapeutic goals.
Delivering handover in an inappropriate manner can put the patient safety at risk
through break in continuity of care and the possibility for adverse events. When
handover is inadequate it results in a situation where the nurse taking over the care
does not have complete knowledge of the care plan, and consequently interventions
may be omitted, engendering the potential for errors. (Vinu & Kane, 2016)

 Observation was done initially on handover practice where the handover took place in
the nurses’ station, to identify the existing good practices and the potential barriers that
 cause gaps in the information. The handover was verbal reporting and a daybook
register in the ward was used as a guidebook for patients’ concise details. The person
giving the handover read out the patient name and concise details from the daybook,
and verbalised any additional interventions performed, or yet to be done. During
handover the staff receiving the handover make a written hand note of the name,
diagnosis and the details needed for care which the nurse feels appropriate, on a piece
of paper. (Vinu & Kane, 2016)

 Ineffective communication has been shown to be one of the leading causes of

preventable medical errors in the United States. (Campbell & Dontje, 2019)

 A key report published by the Joint Commission Center for Transforming Healthcare
(hereafter referred to as The Joint Commission) noted that communication errors
resulted in the most reported sentinel events. Numerous organizations have identified
that communication among nurses is an essential component of safe patient care,
especially during the transfer of patient information from one nurse to another: a
process known as handoff. (Campbell & Dontje, 2019)

 Handover in the health-care setting is recognized as an opportunity for error.

Information can be lost, inaccessible or forgotten during the interaction. Shift to shift
handover is a key process for the transfer of information The Australian Commission on
Safety and Quality in Health Care (ACSQHC) defines clinical handover as the transfer of
professional responsibility and accountability for some or all aspects of care for a
patient, or group of patients, to another person or professional group on a temporary or
permanent basis. Gaps in communication during handover can lead to serious adverse
events, including medication errors, treatment and diagnostic delays, inappropriate
treatment, and omission of care (Debra, kerr, 2014)

 Clinical handover involves the transfer of accountability and responsibility of clinical

information from one health professional to another. The main role of clinical handover
is to transmit accurate, relevant and current details about the patients’ care, treatment,
health service needs, clinical assessment monitoring and evaluation, and goal planning.
Inefficiencies of communication at clinical handover have been associated with
irrelevant, missing or repetitive information, which can result in health professionals
spending extensive periods attempting to retrieve relevant and correct information. In
addition, ineffective handovers can cause major problems relating to lack of delivery of
appropriate care and the possibility of misuse or poor utilisation of resources. (Manias,
Geddes, Watson, Jones, & Della, 2016)
  Ineffective handoffs contribute to gaps in patient care and medication errors, which
jeopardize patient safety and lead to poor-quality care. (Pandya et al., 2019)

 Handover practices are considered a core component in the effective transfer of patient
care among nursing professionals. The failure to share relevant clinical information
about a patient in an accurate and timely manner may lead to adverse events, delays,
inappropriate treatment or an omission of care. noted that different nursing handover
styles might ensure the continuity of information and improved outcomes of the nursing
process. Shift-to-shift nurse handovers occur mainly through face-to-face conversations.
Regardless of the specific practice, the failure to conduct a complete, structured and
logical handover places patients at risk, as the responsibilities associated with patient
care are unclear and may be jeopardized by such ineffective communication. (Pun, Chan,
Eggins, & Slade, 2020)

SKALA DATA

 Approximately 44,000 - 98,000 people die each year due to medical errors.
Communication errors are reported as the key contributory factor in over 70% of all
sentinel events, and omission of detailed patient information frequently underlies these
communication errors. Emphasising the seriousness of this problem, JCAHO noted that
75% of patients affected by these events died. (Vinu & Kane, 2016)

 The Joint Commission (2010) noted that an estimated 80% of serious preventable
adverse events can be attributed to miscommunications between caregivers during
hand-offs. Gawande et al. found that 43% of incidents reported by surgeons interviewed
for their study came from communication breakdowns; specifically, two thirds of those
communication breakdowns involved an inadequate handoff of information or a change
in the personnel providing patient care. (Hunter, H. et al. 2017)

 In a report by the United States (US) Joint Commission, it was reported that breakdown
in communication was the leading cause of delay in treatment, resulting in death or
permanent loss of function, in the period 2004 to 2013. In Australia, Wilson et al.
examined 14 000 hospital admissions for 28 hospitals in two states. An adverse event
resulting in a disability or longer hospital stay occurred for 17% of cases. Of those, 11%
were caused by some form of communication breakdown. Hence, handover problems
are a global concern. Health-care quality bodies, including the US Institute for
Healthcare Improvement (IHI), ACSQHC, British National Patient Safety Agency and
World Health Organization (WHO) advocate the implementation of standardized
approaches, training on effective handover communication and development of
 strategies to enhance the ways in which clinicians communicate and acquire information
during handover. (Debra, kerr, 2014)

 In the same period, quality evaluation of reported safety events with review of medical
records indicated that 60% of medication error events (10 of 17 events) were because of
ineffective handoff communication between clinic and infusion nurses. Ineffective
handoffs can contribute to gaps in patient care, jeopardize patient safety, result in
medication error, and lead to poor quality care delivery. (Pandya et al., 2019)

 Up to 70% of serious errors and sentinel events in hospitals are caused by

miscommunications, 1 of which handoff errors are a leading source. (Starmer et al.,
2017)

 According to the Inspector General Office, Health and Human Services Department, less-
than-competent hospital care contributed to the deaths of 180,000 Medicare patients in
2010. However, the real number may be higher: According to one estimate, between
210,000 and 440,000 patients who go to the hospital each year for care suffer some kind
of preventable harm that contributes to their death. (offori ata 2015)

KRONOLOGI

 Poor communication and lack of structured format are contributing factors in adverse
incidents where patient care is put at risk. (Vinu & Kane, 2016)

 While patient handovers occur between all clinical personnel, and at every level of care,
the focus of this study is the handover that occurs at nursing shift change. In maternity
care, clinical shift handover should be conducted using the ISBAR3 communication tool
that defines the information Technologies are reshaping information management. We
describe the development and implementation of a computerized structured shift
handover tool based on ISBAR3, comprising a printed handover sheet to support sharing
concise, focused information effectively and assertively. This tool reduces the need for
repetition, and improves communication and patient safety. (Vinu & Kane, 2016)

 Standardisation of handover ensures effective, concise and complete communication;

the most critical clinical information is handed over which facilitates the best care
delivery. Numerous studies support the use of standardised tools for handover, and the
need for a structured tool for communication is highlighted in several reports. Health IT
supports clinical handover through the development of tools that facilitate structured
information communication during shift handover. Such communication tools can assist
nursing teams in the fundamental functions of handover, and contribute to competent
 and reliable handover practice by providing updated details of patients in every shift.
(Vinu & Kane, 2016)

 The absence of a structured format and diversity of practice backgrounds made the
handover process inconsistent. Some nurses might give relevant, accurate information in
short time, whereas others might give vague, irrelevant details, which resulted in
unnecessary deviation from the topic and consumed more time. Standardising the
handover structure minimises the demand of recalling from memory, especially at the
end of a long tiring shift. Structured handover avoids omission of pertinent information,
the need for repetition and potential communication breakdown. The use of ISBAR3
communication tool is recommended for handover, and serves as a starting point in our
study. (Vinu & Kane, 2016)

 A verbal only method of handover is insufficient and is liable to significant data loss. The
use of careful note taking during handover vastly improves the amount of information
retained, and the use of a pre-printed sheet containing important patient details almost
entirely eliminates data loss during handover, but this process can be time consuming.
Verbal handover supplemented with a pre-prepared structured handover sheet avoids
the loss of pertinent information, that could result in serious patient morbidity or
mortality. The quantity and quality of information conveyed during shift handover can be
expected to improve if a structured format is used. There is no evidence to show the
most effective method of handover, however it is suggested that a standardised
approach to handover communications, including a chance to ask and respond to
questions works best. Implementation of a standardized structured handover template
and training to improve compliance to established standards, will foster quality of care,
and protect patient safety. Standardised methods for handover communication are now
agreed Internationally and recommended by WHO and Joint Commission International.
It is recommended that shift clinical handover should be conducted using the ISBAR3
communication tool (Identify, Situation, Background, Assessment, Recommendation,
Responsibility, Risk) as a structured framework, which outlines the information to be
transferred. The tool may be available in written format but electronic is preferred. The
aim of this National Clinical Guideline is to describe the elements that are essential for
timely, accurate, complete, unambiguous and focused communication of information in
maternity services in Ireland. (Vinu & Kane, 2016)

 ISBAR3 (Identify, Situation, Background, Assessment and Recommendation) is the

mnemonic created to improve safety in the communication of vital information by
providing a framework for communication. ISBAR3 originates from SBAR, and is the most
frequently used mnemonic in health and other high-risk environments such as the
 military. The add-on ‘I’ in ISBAR3 is to ensure that accurate identification of the patient
and of those participating in handover is established. The use of ISBAR3 for use at
handover is recommended, and it is important that there is a mandatory protected time
for this handover. The expected outcome is that all communication (clinical handover)
between healthcare staff in maternity services will be conducted using a structured
communication tool, promoting standardisation of practice and minimisation of
variability, thus reducing risk for patients. (Vinu & Kane, 2016)

 Implementating ICT to support electronic clinical handover systems must be considered

in the context of a standards based approach. Complete information transfer and
retention are less effective with verbal handovers or verbal with note taking than printed
handouts with relevant patient information. Existing research suggests that technology
should be utilised to support the verbal report, rather than replacing it. (Vinu & Kane,
2016)

 Communication breakdown is one of the main causes of adverse events in clinical

routine, particularly in handover situations. The communication tool SBAR (situation,
background, assessment and recommendation) was developed to increase handover
quality and is widely assumed to increase patient safety. The objective of this review is
to summarise the impact of the implementation of SBAR on patient safety. (Müller et al.,
2018)

 The Clinical handover process and the standardisation of such a process has been
recognised as being crucial to maintaining and promoting effective communication and
patient safety across the world with varying systems being used. (Beament, Ewens,
Wilcox, & Reid, 2018)

 Handoff in the emergency department is considered a high-risk period for medical errors
to occur. Medical errors that have been identified within the emergency department
include falls, administration of medication, administration of blood, and a deficiency of
infection control practices. Common factors in the emergency department, such as
multiple interruptions, alarms, noise, attempts to multitask and overcrowding,
negatively affect the handoff process.6 As emergency departments have high patient
turnover, high patient acuity, and unpredictable patient volumes, the transfer of patient
information among nurses in this setting might be inadequate and unsafe. Because of
the risk factors that might be associated with handoff in the emergency department,
using bedside handoff can assist with providing safe patient care. (Campbell & Dontje,
2019)
  There has been considerable focus on inter-shift nursing handover over the past decade
in Australia and internationally. Handovers have been shown to be time consuming,
inconsistent and varied in style. Catchpole et al. identified that health-care professionals
were concerned about poor awareness of handover protocols; poor team coordination;
time pressure; lack of consistency in handover practice; and poor communication of
important information. (Kerr, Klim, Kelly, & Mccan 2016)

 Preliminary research at the ED in which this study was conducted found that nursing
handover often lacked important information, was rarely conducted in front of the
patient and medication charts were rarely sighted during this activity. Nurses also
reported a preference for handover to be conducted for allocated patients only, to be
performed at the patient’s bedside, and systematically cover essential information
including patient detail, presenting problem, treatment, nursing observations and the
proposed future plan. Arising from these concerns, a structured and systematic
handover framework was developed . The framework was specifically modified to
address deficits in nursing care practice. For example, emphasis was placed on viewing
the patient’s charts for medication, vital signs and fluid balance. This provides an
opportunity for omissions of information, documentation, or care to be identified and
addressed at the commencement of a shift. (Kerr, Klim, Kelly, & Mccan, 2016)

 An effective patient transfer, or handover, among healthcare professionals can help

prevent communication-related medical errors, and a reliable electronic handover
informatics system can standardize the handoff process. Studies have shown that
handover via electronic technology can integrate and disseminate patient information
more efficiently and accurately. The development of electronic handover informatics
systems (HISs) has been slow compared to the implementation of electronic medical
records (EMRs) for diagnosis, prescription, and laboratory tests in Taiwan hospitals (Lee,
Lin, & Lin, 2019)

SOLUSI

 The use of structured, standardised tools helps to ensure standardistaion; thus orderly
thought is conveyed in a concise and thorough way to uphold patient safety. The ISBAR3
(Identification, Situation, Background, Assessment, Recommendation/
Responsibility/Risk) mnemonic is a conceptual framework specifically developed for
multidisciplinary patient related information sharing and communication Use of ISBAR3
promotes consistency during handover while transferring the patient’s information. The
template aids in the transfer of information in an expected pattern so that the good
communication improves patient safety by avoiding or reducing omissions and errors.
(Vinu & Kane, 2016)
 Based on the initial observation findings, the identified factors are incorporated with
National guideline in the development of a structured ISBAR3 handover template
specific to gynaecology patients. The ISBAR3 format helps nurses to structure their
communication in a logical sequence, facilitating rapid comprehension, henceforth
reducing the length of handover. It enables them to clarify what information should be
communicated, and how. It permits the staff to communicate assertively and effectively,
reducing the need for repetition. (Vinu & Kane, 2016)

 At first the format was piloted with the senior nursing team and necessary corrections
were made according to the ward setting. The template was then introduced to the staff,
which was on the computer in a Word format and each nurse updates their patients’
details towards the time of handover. The details were not saved in the computer for
confidentiality and data protection. So it was deleted once the patient was discharged.
The daybook described that is used as the basis for verbal handover, also was amended
to conform with the ISBAR3 template to maintain accuracy and consistency. (Vinu &
Kane, 2016)

 The main areas of change in the introduction of electronic clinical handover systems is in
accuracy and in the scope of the information that is handed over, and a reduction in the
time for handover to occur. The implementation of a structured nurse shift handover is
perceived to improve communication between carers, and improve patient safety. We
demonstrate a statistically significant improvement in the amount of information
exchanged in shift handover. (Vinu & Kane, 2016)

 Using IT in nurse shift handover is an effective method for improving quality, efficiency,
and reducing costs. The use of the computerised structured format provides a prompt
for critical information, and helps to ensure that information is not overlooked. It also
provides guidance for additional information, such as the set of tasks to be completed,
people to be contacted and reports to be followed up. (Vinu & Kane, 2016)

 As well as improving staff satisfaction and patient safety, the time saved using the
structured format has positive implications for hospital efficiency, effectiveness and
patient care. (Vinu & Kane, 2016)

 Effective handoffs can help decrease adverse events and improve outcomes. The
importance of bedside handoff should not be underestimated, as it can be a successful
approach to incorporating patients and families along with nurses in the safe transition
of care. (Campbell & Dontje, 2019)

 Various strategies have been developed to enhance the effectiveness and efficiency of
nursing handover, including standardized approaches, bedside handover and technology.
The majority of these models have been evaluated in inpatient settings; few have been
conducted in ED (Emergency Departmen) In the UK, Currie identified handover
problems, including missing information, distractions and breaches of confidentiality.
(Kerr, Klim, Kelly, & Mccan 2016)
 Keaslian Penelitian
No Judul Penelitian dan Nama
Peneliti
1 The use of a digital
structured format for nursing
shift handover to improve
Communication.
(Vinu & Kane, 2016)
2 Effects of the I-PASS
nursing
handoff bundle on
communication
quality and workflow.
(Starmer et al., 2017)
Metode
Desain Penelitian:
One group pra – post test design
Sampel:
15 nurses (20 shift handovers)
Variabel Independen: Electronic
clinical handover
Variabel Dependen:
Handover practices
Instrument:
ISBAR3 handover tool with e-
technology, questionnaire.
Analisis:
Uji Chi Square
Desain Penelitian:
One group pra – post test design
Sampel:
90 Nurse (126 handoffs)
Variabel Independen:
I-PASS Method
Variabel dependen:
Handoff (communication
quality and workflow)
Instrument:
I-PASS nursing handoff bundle
Analisis:
χ2 tests
Hasil
1. The time taken for handover has
substantial reduced from an
average of 31 minutes to 27
minutes (1.7 minutes to 1.5 minutes
per patient), i.e. 4 minutes in each
handover. Use of an electronic
structured format replaced the
traditional way of handover to a
systematic, precise, accurate,
relevant mode of updated
communication in a very short
period of time.
2. As well as saving time,
implementation of the ISBAR3
handover tool enhances
communication, and reduces the
risks to patient safety.
I-PASS implementation was
associated with
improvements in verbal
handoff communications,
including inclusion of illness
severity assessment (37%
preintervention vs 67% post
intervention, p=0.001),
patient summary (81% vs
95%, p=0.05), to do list
(35% vs 100%, p<0.001)
and an opportunity for the
receiving nurse to ask
questions (34% vs 73%,
p<0.001). Overall, 13/21
(62%) of verbal handoff data
elements were more likely
to be present following
implementation whereas no
data elements were less
likely present.
Implementation was
associated with a decrease
in interruption frequency pre
versus post intervention
(67% vs 40% of handoffs
with interruptions, p=0.005)
without a change in the
median handoff duration
(18.8 min vs 19.9 min,
p=0.48) or changes in time

3 Implementation of an SBAR Desain Penelitian:
communication program Quasi experimental design
based on experiential
learning theory in a pediatric A class (experimental group) and B (p < .001), communication
nursing practicum.
(Uhm, Ko, & Kim, 2019)
4 The impact of situation-
background-assessment-
recommendation (SBAR) on
safety attitudes in the
obstetrics department.
(Ting, Peng, Lin, & Hsiao,
2017)
5 Handover of patients from
prehospital emergency
services to emergency
departments.
(Sanjuan-Quiles et al., 2019)
6 Training in communication
and interaction during shift-
to-shift nursing
handovers in a bilingual
Sampel:
class (control group). Six teams per
class were composed of 6 or 7
nursing students.
Variabel Independen:
SBAR
Variabel dependen:
Communication performance, satisfaction did not differ.
communication perception, and
practicum-related outcomes.
Instrument:
SBAR communication
Analisis:
Chi-squared tests,
independent t-tests
Desain Penelitian:
One group pra – post test design
Sampel:
29 nurse pre intervention survey, 34
nurse first post intervention , 33
second post intervention.
Variabel Independen:
SBAR
Variabel dependen:
Safety attitudes, apgar scores.
Instrument:
Safety attitudes questionnaire
(SAQ), SBAR collaborative
communication education
Analisis:
Wilcoxon rank-sum test, chi-square
test.
Desain Penelitian:
Qualitative research
Sampel:
12 nurses
Variabel Independen: Nurse
experience of patient handovers
Variabel dependen:
Quality of handovers
Instrument:
10 open-ended questions
Analisis:
Desain Penelitian:
Case study
Sampel: 50 nurses (80 handovers)
Variabel Independen:
spent in direct or indirect
patient care activities
The experimental group
demonstrated significantly
higher SBAR communication
clarity (p < .001), and
handover confidence (p < .
001) than the control group.
Clinical practice selfefficacy,
perceived nurse–physician
collaboration, and practicum
Most values, including
teamwork climate, safety
climate, job satisfaction, and
working conditions,
significantly improved at
both postintervention
surveys compared with the
preintervention survey.
There were no significant
differences in the number of
the neonates with less than
seven 5-minute Apgar
scores between the pre- and
postintervention periods
Nurses identified the need
to standardize the patient
transfer process by a written
record to support the verbal
handover and to transmit
patient information
adequately, in a timely
manner, and in a space free
of interruptions, in order to
increase patient safety.
Three areas likely to
enhance the continuity of
care emerged:
1. Explicit transfer of
 hospital. ISBAR and CARE protocol responsibility by outgoing
(Pun, Chan, Eggins, & Variabel dependen: nurses
Slade, 2020) Perceptions and practices nurse 2. Responsible engagement
handover of incoming nurses in the
Instrument:
handover.
ISBAR checklist and CARE
protocol training 3. Adherence to a
Analisis: systematic handover
structure.

7 Ensuring effective care Desain Penelitian: The proportion of

transition communication: One group pra – post test design medication errors as a result
implementation of an Sampel: of ineffective handoffs was
electronic medical record– 42 nurses reduced from 10 of 17 (60%)
based tool for improved Variabel Independen:
pre-intervention to 11 of 34
cancer treatment handoffs Electronic medical record handoff
between clinic and infusion Variabel dependen: (32%) postintervention (P
nurses. Effective care transition = .07). The EMR-based
(Pandya et al., 2019) communication handoff tool was used in
Instrument: 9,274 of 10,910 (85%)
SBAR electronic medical record patient treatment visits, and
handoff tool. the handoff completion rate
Analisis: increased from 32% pre-
T test and x2/Fisher’s exact intervention to 86%
test
postintervention. Patient
waiting time showed an
average reduction of 2
minutes/patient/month. A
majority
of nurses reported that the
new tool conveyed
necessary information (85%
of nurses) and was effective
in preventing errors (81% of
nurses).
8 Perspectives of clinical Desain Penelitian: Many health professionals
handover processes : a multi- Cross sectional reported being aware of
site survey across different Sampel: adverse events where
health professionals. 707 health professionals they noticed poor handover
(Manias, Geddes, Watson, participated (response rate = 14%).
was a significant cause.
Jones, & Della, 2016) Represented professions were
nursing (60%), medicine (22%) and Differences existed between
allied health (18%). health professions in terms
of how effectively they gave
Variabel Independen: handover, perceived
The perceptions and experiences of effectiveness of bedside
health professionals of different handover vs. nonbedside
disciplines. handover, patient and
Variabel dependen: family involvement in
Clinical handover
handover, respondents’
Instrument:
The Survey- Monkey database confirmation of
Analisis: understanding handover
 Chi-square analysis from their perspective, their
observation of senior health
professionals giving
feedback to junior health
professionals, awareness of
adverse events and severity
of adverse events relating to
poor handovers.
9 Perceptions and experiences Desain Penelitian: Results showed three major
of hospital nurses during Qualitative themes: “Perceptions of
transition to an electronic Sampel: challenges and barriers
handover informatics 38 nurses related to the transition to a
system. Variabel Independen:
new handover informatics
(Lee, Lin, & Lin, 2019) Perceptions
and transition experiences nurse system,”
Variabel dependen: “Perceptions of benefits and
Handover informatics systems strategies to the transition
(HIS) to a new handover
Instrument: informatics system,” and
Questions abaout Perceptions of “Suggestions
implementing HIS, Coping for successful
strategies and Adaptation implementation of a new
Experience.
handover informatics
Analisis:
system.” Five subthemes
emerged from the first
theme, and six subthemes
emerged from the second
theme.
10 Impact of the Desain Penelitian: Eight studies with a before–
communication and patient Systematic review after design and three
hand-off tool SBAR on Sampel: controlled clinical trials
patient safety: a systematic 11 articles performed in different
review. Variabel Independen:
clinical
(Müller et al., 2018) Impact of the communication and
patient hand-off tool SBAR settings met the inclusion
Variabel dependen: patient criteria. The objectives of
safety the studies were to improve
Instrument: team communication,
SBAR tool patient hand-offs and
Analisis: communication in telephone
calls from nurses to
physicians. The studies were
heterogeneous with regard
to study characteristics,
especially patient outcomes.
In total, 26 different patient
outcomes were measured,
of which eight were reported
to be significantly improved.
Eleven were described as
improved but no further
statistical tests were
 reported, and six outcomes
did not change significantly.
Only one study reported a
descriptive reduction in
patient outcomes.
11 A tailored intervention to Desain Penelitian: The intervention did not result in an
improving the quality of Quasi experimental design. improved perception of handover
intrahospital nursing Sampel: quality by ward and ICU nurses. There
Handover. 130 nurses was improvement in the perception of
(Bergs et al., 2018) Variabel Independent: Interaction and support among
Tailored intervention emergency department nurses. The
Variable Dependen: intervention positively effected
Quality of nursing handover teamwork and mutual understanding
Instrument: concerning nursing handover practice
Handover Evaluation Scale (HES) amongst emergency nurses.
questionnaire
Analisis
Mann-Whitney U test
12 A collaborative approach to Desain Penelitian: The use of an interprofessional
the implementation of a Mixed methods, quantitative, educational program increased the
structured clinical handover qualitative, descriptive survey confidence and understanding of a
tool (iSoBAR), within a design, using pre and post survey. range of health care practitioners when
hospital setting in Sampel: using the clinical handover tool
metropolitan Western 29 nurses, doctors and allied health iSoBAR.
Australian. personnel employed
(Beament, Ewens, Wilcox, & Variabel Independent:
Reid, 2018) Education intervention
Variable Dependen:
Implementation of the clinical
handover tool iSoBAR.
Instrument:
Power point presentation, and a
simulation video, questionnaire.
Analisis:
T-tests, Mann-Whitney U test, Chi-
square/ Fisher's exact test, Z-Tests.

13 Implementing bedside
handoff in the emergency
department : a practice
improvement project
(Campbell & Dontje, 2019)
Desain Penelitian: One group pra – Results showed that nurses found the
post test design SBAR bedside report method easy to
Sampel: 230 Nurses. use and prevented the loss of patient
Variabel Independen: information more effectively than pre-
SBAR Bedside handoff intervention practice.
Variabel dependen:
Handoff, Patient safety
Instrument:
SBAR tool, nursing handoff
questionnaire The Agency for
Healthcare Research Quality
(AHRQ)
Analisis:

14 Nurses’ perceptions of Desain Penelitian: Most nurses strongly value

mandatory bedside clinical Cross sectional bedside handovers and have
 handovers : an Australian Sampel: 66 nurses
hospital study Variabel Independen:
(Slade, Murray, Pun, & Nurses perceptions
Eggins, 2019) Variabel dependen:
Bedside handovers
Instrument:
the Bedside Handover
Attitudes and Behaviours (BHAB)
questionnaire.
Analisis:
The McNemar test
15 Impact of a modified nursing Desain Penelitian:
handover model for One group pra – post test design
improving nursing care and Sampel: 126 nurses
documentation in the Variabel Independen:
emergency department : A Modified nursing handover model
pre-and post-implementation Variabel dependen:
study. Nursing care and documentation
(Kerr, Klim, Kelly, & Mccan Instrument:
ED structured nursing handover
framework.
Analisis:
Chi-square, t-test
16 Compliance with a Desain Penelitian:
structured bedside handover Multicentred observational study
Protocol : an observational, Sampel:
multicentred study. 638 observations handover
(Malfait et al., 2018) Variabel Independen:
ISBARR
Variabel dependen:
Compliance with a structured
bedside handover
Instrument:
Handover protocol following
ISBARR
Analisis:
One-way ANOVAs and multilevel
analysis
confidence in their ability to
lead this clinical practice.
Results showed significant
improvements in several
processes: handover in front
of the patient (P < 0.001),
patients contributed and/or
listened to handover
discussions (P < 0.001), and
provision of adequate
information about all
patients in the department
(P < 0.001). Nurses also
reported a reduction in
omission of vital signs (P =
0.022) during handover.
Three hundred sixty-eight
medical records were
audited in the two study
periods: 173 (pre-
intervention) and 195 (post-
intervention). Statistically
significant improvements in
the completion of two
nursing care tasks and three
documentation items were
identified.
When the bedside handover was
delivered, compliance to the structured
content was high, indicating that the
execution of a bedside handover is a
feasible step for nurses. The
compliance rate was influenced by the
patient’s length of stay, the nursing care
model and the type of ward, but their
influence was limited. Future
implementation projects on bedside
handover should focus sufficiently on
standard hospital procedures and
patient involvement. According to the
nurses, there was however a high
number of situations where bedside
handovers could not be delivered,
 perhaps indicating a reluctance in
practice to use bedside handovers.
17 Patient and nurse Desain Penelitian: the results of this DCE can
preferences for nurse Qualitative inform our
handover—using Sampel: three main aims by:
preferences to inform Patients 20, nurses 10 1. Identifying, comparing
policy : a discrete choice Variabel Independen:
experiment protocol. Patient and nurse preferences
and contrasting how
(Spinks, Chaboyer, Variabel dependen: different attributes are
Bucknall, Tobiano, & Bedside handover perceived by patients
Whitty, 2015) Instrument: and nurses and
Discrete choice experiment (DCE) especially to identify
protocol any disconnect. This is
Analisis: important as the two
groups are likely to have
different, if overlapping,
preferences for how
handover is conducted
in hospitals.
2. Identifying any
attributes that may be
causing nursing staff not
to undertake handover
in a manner that
encourages patient
participation in the
bedside handover, as
per the recommended
guidelines. This is
important within a
knowledge translation
framework as if we
understand the barriers
to bedside handover, we
can target specific
strategies to overcome
them and increase the
likelihood of uptake.
18 Smartphone preventive Desain Penelitian: A total of 262 persons accessed the
health care: parental use of Descriptive study design application’s website. The application
an immunization reminder Sampel: was downloaded and used by 45 of
system. 100 patients those persons during the study; six
(Peck, Stanton, & Reynolds, Variabel Independen: persons completed the survey.
2014) Smartphone preventive
health care
Variabel dependen:
Parental use of
an immunization reminder
system.
Instrument:
Android smartphone
Application
Analisis: