Effectiveness of Using Communication Tool in Clinical Handover To Enhance Patient Safety

This research explores the importance of communication in clinical handover to manage safety of patients, especially critical and aged patients. The primary objective is to establish relationship between clinical handover and patient risk management. The research includes substances drawn from reliable government websites, especially from Australia and international organisations. The outcome of the research is that communication plays important role in effective clinical handover. Key words: Clinical handover, communication, risk management, medical practitioners

Running Head: ASSIGNMENT 2
Effectiveness of Using Communication Tool in Clinical Handover To Enhance Patient Safety
In Hospital Setting
Students ID
Name of the University
Authors Note

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ASSIGNMENT 2
Executive summary:
The background of the research is set against the healthcare industry in Australia and revolve
around an area of serious medical important, clinical handover. The background also explores
the importance of communication in clinical handover to manage safety of patients,
especially critical and aged patients.
The primary objective of the research is to establish relationship between the two recognised
variables namely, clinical handover and patient risk management. This main objective would
supported by a second objective which is to establish the importance of communication in
clinical handover to achieve the patient safety, the second variable of the primary objective.
The inclusion criteria of the research consists of importance of communication with respect
to clinical handover and patient risk management. The research includes substances drawn
from reliable government websites, especially from Australia and international organisations.
The research does not include aspects like motivation and human resource management in
hospitals.
The participants of the research are patients and medical practitioners from Australian
hospitals. The government protocol and laws regarding clinical handover have worked as
important intervention.
The research has taken into account both secondary and primary data. The secondary data
includes both government websites and articles.
The outcome of the research is that communication plays important role in effective clinical
handover. Clinical handover is important for safety and wellbeing of patients, which means
the primary objective of the research achieved.

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ASSIGNMENT 2
The search strategy for the research was analysis and study of a large number of articles.
Finally, most of the articles had to be discarded due to lack of reliability and the finally
selected articles were used for the analysis.
The research methodology included both primary and secondary data. The data extraction
process comprised of incorporating pieces of reliable data which were assorted using the
search strategy. The data was synthesised with the data collected from reliable websites and
primary data to give shape to the research.
The result of the research was that communication is very important for clinical handover in
an effective way. Finally, it can be concluded that the medical practitioners should ensure
appropriate clinical
Key words: Clinical handover, communication, risk management, medical practitioners

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ASSIGNMENT 2
Table of Contents
Introduction:...............................................................................................................................6
Significance of the project.........................................................................................................6
Designs.......................................................................................................................................7
Overview of the study................................................................................................................8
Background and literature..........................................................................................................8
Organisational cultural factors...............................................................................................8
Clinical handover and patients’ health risk management:...................................................10
Importance of communication in clinical handover:...........................................................13
Objectives of the research:.......................................................................................................15
PICO (Problem, Intervention, Control and Outcome):........................................................16
Methods of the review:.............................................................................................................16
Justification of the methods chosen:....................................................................................16
Data extraction:....................................................................................................................17
Data synthesis:.....................................................................................................................17
Review results:.........................................................................................................................18
Description of studies (Appendix 2):...................................................................................18
Results......................................................................................................................................19
Systematic process of review...............................................................................................19
Quality evaluation....................................................................................................................20
Discussion:...............................................................................................................................21

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ASSIGNMENT 2
Conclusion:..............................................................................................................................21
Implications of the practice:.....................................................................................................22
Implications of the research:....................................................................................................22
References:...............................................................................................................................23
Appendix:.................................................................................................................................26

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ASSIGNMENT 2
Introduction:
The landscape in the healthcare in Australia have evolved to a tremendous level to
cater to needs of the patients. The healthcare professionals today have to modify the
healthcare systems according to the needs of the patients to ensure round the clock safety of
the latter. The professionals like the nurses and doctors have to handover the responsibility of
care of the patients to their next counterparts. Communication plays a tremendously
important role in ensuring effective clinical handover before the healthcare staff members
(Williams, 2018). This is because clinical handover involves exchange of medical
information and accountability to the next professional in the shift. Improper handover can
result in deterioration in the health condition or even death of the patients. This risk posed by
clinical handover onto the patients have led to countries like the United Kingdom and
Australia pass laws to ensure effective handover of clinical responsibilities from staff
members of one shift to the staff members of the next shift. Effective communication in
clinical handover are not restricted to the medical staff members alone but also encompass
the senior medical staffs as well, if required to ensure physical wellbeing of the patients. The
medical staff holding higher levels in the hierarchy are entrusted with the responsibility of
ensuring effective clinical handover between staff members of two successive shifts. The
medical facilities like hospitals today use computerised records of clinical handover to ensure
smooth transfer of responsibilities. These effective communication regarding clinical
handover has proved to be of great value in Australia which boasts one of the most advanced
healthcare environment in the world (Safetyandquality.gov.au, 2018). The paper would delve
into this role of effective communication to ensure effective clinical handover to ensure
security and wellbeing of the patients.

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ASSIGNMENT 2
Significance of the project
The Australian resource centre for healthcare innovation was contracted by the
Australian council for quality and safety in Health Care for offering a standard operating
protocol that is necessary for the taking part in world’s health organisation. However,
improved longevity and changing lifestyle are putting huge pressures on the all the healthcare
systems around the world.
Hospitals settings therefore, needs to manage rapidly growing number of patients who
are increasingly present with the complicated chronic condition. To improve these chronic
situation of the patient, clinical handover is necessary in medical care settings. In this context,
clinical handover refers to the transfer of the professional responsibility and accountability
for all the required aspects of care provision for the patient to another individual on a
temporary basis.
However, due to changing conditions of work in health care settings clinical handover
has become a necessary task. The Australian national safety and Quality health service
standards offers the external criteria in different care settings to evaluate the practise. In order
to avoid and reduce errors in communication and treatment of the patients, clinical handover
is important to understand in all healthcare settings.
Aim
The main aim of the project is to evaluate the effectiveness of communication taking
place through clinical handover in health care settings. Based on this the study has
investigated the emerging activities of clinical handover and existing trends in health and
communication method that influences on the service user.

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ASSIGNMENT 2
Designs
All the designs and method of the project have been conducted through integrative
and rapid review of literature using various electronic database such as CINAHL, SCOPUS,
and COCHRANE library. The project has been performed through comprehensive literature
search through rapid reviews using multiple bibliographic electronic databases. Grey
literature was searched in a thorough way and the health technology evaluation based on
clinical handover were surveyed to recognise the additional review of the literature.
However, detailed data has been collected from the literature review and reporting
sources that are close to the rapid review search strategies. In this regards, the quality of
conduct and reporting of rapid review have been evaluated using the A measurement Tool to
analyse the systematic (AMSTAR) and preferred reporting items that are necessary for
required for systemic reviews. Therefore, compliance with each of checklist was effectively
examined with the sum of reported items in the systematic review to illustrate the overall
compliance.
Overview of the study
Background and literature
Organisational cultural factors
Communication is the process of cooperation that usually has four major
elements including sender, the message, the recipients and the feedback. However,
Anderson et al., (2015) stated that communication is highly influenced owing to personal
feelings and those can be framed by the organisational culture. Therefore, it is essential
within the organisational context that communication is considered while framing process of
clinical handover. The studies in this context are limited.

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ASSIGNMENT 2
As stated by Peter et al., (2015), improved longevity and changing lifestyles are
putting increased pressures on the operations of clinical settings. Therefore, it is increasingly
becoming essential for hospitals to manage the growing number of service users, which are
growingly present with the complicated co morbidities and chronic situation.
However, one of the indicators of these increasing pressures is due to the high
percentage of avoidable service harm in hospitals that accounts to almost 10% in the
establishing countries, and that is potentially higher in the developing countries. However, it
has been estimated from various sources that Australia alone has almost 500,000 people who
suffered from unavoidable treatment in hospitals (Williams, 2018).
Therefore, ineffective communication is now increasingly well identified contributor
for preventing patient centred harm taking place hospitals. According to Ding et al., (2016),
for certain period time research suggested that clinical handover is a critical site for managing
communication issue, for instance, a current large-scale European Commission project
reported that handover in clinical communicable is accountable for almost 25% to 40% of
dangerous events in hospital settings (Abraham et al., 2014).
Estimates in this context shows that number of clinical handovers in Australia is more
than 40 million and in USA it is more than 300 million representing that handover is arguably
the most frequently used communication process in between health care employees and in
delivery of patient oriented care.
On the contrary, Sassoli & Day (2017) argues that lack of communicative data within
clinical care settings may make it impossible to demonstrate the practical as well as
standardised handover protocols. Data in this context shows that contextual issues of hospital
settings often helps to resolve against effective communication thereby compromising over
the clinical Handover (Yu & ja Kang, 2017). For the purpose of clinical handovers,

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ASSIGNMENT 2
healthcare members and managers are required to manage the major contextual factors of
participants, planning, and resources as well as organisational environment. Failure to
manage these areas may amount to insufficient tolerance to risky issues.
Clinical handover and patients’ health risk management:
Clinical handover in appropriate ways plays a significant role in ensuring safety of
patient and the physical wellbeing of the latter. The Australian Commission on Safety and
Quality in Health Care reports that more than seven million clinical handovers take place in
Australian hospitals and over twenty six million handovers take place in the community
care centres (Safetyandquality.gov.au, 2018). These two figures that a colossal amount of
clinical handovers take place in Australia which places immense challenge to the
professionals to ensure safety of the patients under charge. The report further points out that
face to face communication between the medical practitioners result in more effective clinical
handovers. However, this method of handovers also attracts the risks of loss of clinical
information since the entire communication as well as implementation of the treatment is
reliant on the memory skills of the medical staffs (respondents of primary analysis of the
research).

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ASSIGNMENT 2
Figure 1.Graph showing number of deaths due to falls while stay in hospital
(Source: Aihw.gov.au, 2018)
The graph above published by the Australian Institute of Health and Welfare,
Government of Australia shows that number of patient deaths due to fall while being
admitted in hospital between periods of 2015-2016. The graph shows that the fall rates
increase with the age when patients lose their locomotion power. The World Health
Organisation in its bulletin reports that the occurrences of patient death due to lack of care
from the side of the medical practitioners are often not recorded and reported (Who.int.
2018). Thus, here it can be inferred from the graph published by the Australian Institute of
Health and Welfare, Government of Australia and the WHO that the role of improper clinical

12
ASSIGNMENT 2
handovers due to cannot be underestimated. The Australian Commission on Safety and
Quality in Health Care in this regard further reports that lack of communication between the
medical staff members results in poor handover of clinical responsibilities, delays in
treatment, repeated medical tests, incorrect treatments and medication errors, all of which are
capable of causing death of patients. Kaye et al. (2015) shed light on the role of clinical
handover towards patients’ health risk management. They throw light on the fact that
improper clinical handover does not only cause risks to aged patient but also to patients under
critical medical conditions like pregnancy. Lack of proper clinical handover and
communication gaps between staff members of hospital have culminated in pregnancy
trauma as well as other medical complications. Perkins et al. (2016) makes the arguments of
the previous stronger by pointed a second risk which improper clinical handovers can attract-
legal risks. The patients or their representatives may file cases against the hospitals due to the
lack of improper treatment which might have stemmed due to improver clinical handovers.
Thus, clinical handovers done in inappropriate methods do not create risks for the patients but
the organisations as well. An analysis of these sources of information clearly shows that the
appropriate clinical handovers plays very significant role in risk management of patients as
well as to the hospitals.

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ASSIGNMENT 2
Improper clinical handover
Patient liferisks (risk to patient wellbeing)
Legal risks (Risk to the hospital)
Figure 2. Risks due to inappropriate clinical handover
(Source: Perkins et al. 2016)
Importance of communication in clinical handover:
Communication holds tremendous importance in clinical risk management especially
in case of clinical handover. This makes it very crucial for medical practitioners to maintain
continuous communication while serving patients. Primdahl (2015) sheds light on the
seriousness of the role of communication in taking care of cardiovascular patients who need
uninterrupted medical attention. Kitas (2015) introduces another category of patients in need
of continuous medical attention, the patients suffering from arthritis. Preiser et al.(2015) point

14
ASSIGNMENT 2
out that patients suffering from neurological problems and balance issues need continuous
attention as well as assistance of medical attendants. These categories of critical patients
(respondents of primary analysis of the research) are in continuous need of support and
assistance of nurses. Asfaw, (2015) further points out that continuous attendances of nurses
and carers acts as mental support for patients. This mental support motivates them to recover
faster, thus promoting to their wellbeing. Thus, it is clear from the discussion that patients,
especially critical patients require continuous attention from carers. This necessitates the
medical staff maintain smooth communication among themselves while changing shifts.
Hailemariam et al.(2016) further mentions that medical practitioners should exchange
complete information about the medical requirement of the patients under charge. This is
very critical to ensure appropriate medication and speedy recovery of the patient. Thus, it can
be inferred that the communication plays significant role in clinical handover to ensure
management of risks to health of the patients.
Challenges in the process of clinical handover
According to Redley et al., (2017) sources found from a survey report of summative
content evaluation of almost 130 patinets that contexts of clinical handovers were not
performed in a holistic way. In addition to the analysis of tape recorded data shows that
clinical handovers does not structured content. The content consisted of differ net style of
presentation, irregular body and incomplete narration.
Miller et al., (2018) stated that another major sub themes that has been deduces from
the study is that nurses often are seen to have low ethical and lack of practical engagement.
In this context, data revived from multiple sources found that in spite of the case method
system that is being carried out, the nursing care providers did not have any active role in the
process of handover.

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ASSIGNMENT 2
Moreover, the data from observations received from various resources and tape
records found that clinical handovers were not based on ethics. As stated by Watson et al.,
(2015) poor management during clinical handover practices were seen to be another major
issue. In this context, interviews data and several field observation reported that time and
space of handover were not managed in an effective way, there were poor management of
time, hasty reports with several interruptions during the process of clinical handover.
Objectives of the research:
The review objectives of the research would be to study the relationship between two
variable elements. The first variable is the effectiveness of communication in clinical
handover and the second variable would be patient safety. The criteria considered for the
research would be secondary sources like articles and works by different authors as well as
information available on reliable websites.
Criteria for considering studies for the review:
Types of studies
The studies conducted were concerned with systematic review that examined methods to
limit and prevent the clinical errors during the process of clinical handover in different
medical care stings. In this, the nursing care providers concerned the studies with the
effective use of communication while performing clinical handover.
Types of participants’
The participants of the project are the nursing care providers and registered nurses, endorsed
registered nurses with an authority to clinical handovers and communication.
Types of intervention

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ASSIGNMENT 2
All the strategies used by the care providers is to enhance the communication to increase the
safety of clinical handover while dealing with patents in acute and healthcare settings. The
studies also considered controlled RCT trials and other components of clinical process.
PICO (Problem, Intervention, Control and Outcome):
The paper would deal with the problem of risk to wellbeing of patients due to
improper clinical handover. The intervention in this case can be proper recording of clinical
handover and data maintenance using electronic method. This would enable hospital
managers ensure that the clinical handovers take place efficiently. The hospital in order to
control clinical handovers should provide complete patient treatment data to the carers. This
would ensure proper treatment of the patient, thus minimising risks to their wellbeing. The
outcome of efficient clinical handover would be reduction in patient injury or death due lack
of care as a consequence of improper clinical handover.
Methods of the review:
The tools and methods used in the research was associated with secondary analysis. This
secondary analysis would lead to study of immense amount of work done in the field of
clinical handover. Moreover, the hospitals and the medical centres while executing clinical
handover have to follow the laws and protocols laid down by the Government of Australia as
well as the government of the domicile state(s). This makes it pertinent for the thorough study
of government websites and articles related to clinical handover (Safetyandquality.gov.au,
2018). The next research method was secondary analysis methods through systematic reviews
of AMSTAR.
Justification of the methods chosen:
It can be justified that both secondary analysis are important to conduct research on
the topic mentioned. This is because clinical handover is a critical area of medical treatment

17
ASSIGNMENT 2
and already has an immense of literature dedicated to it. Further, the medical practitioners
have to follow the protocols laid down by the government of Australia. This makes it
important to study the secondary data sources. The research on the relationship between
clinical handover and patient health risks would also require primary analysis of RCT studies.
Secondary analysis would enable getting deeper insight into the issue of clinical handovers.
Thus, it can be justified that both secondary and primary analysis are important to carry on
the research.
Data extraction:
The data extraction would take place both from secondary as well as from primary
data as well from secondary data. This would lend richness to the research. The study has
been conducted in a regional hospital setting located in Australia that provides range of
inpatient services including emergency services.
Data synthesis:
The data synthesis would take place by amalgamation of using review system. The
presentation would take place in form of a report.

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ASSIGNMENT 2
Total articles
originally
retrieved
(n=1437)
Papers retrieved
for detailed
examination
(n=955)
Number of duplicates
removed
(n=482)
Full articles retrieved for further
examination
(n =33)
Papers not relevant after review of
abstracts
(n=922)
Papers excluded for not meeting the
inclusion criteria
(n=14)
Full articles retrieved for further
examination
(n =19)
Paper excluded after quality
assessment
(n= 3)
Papers included in
review
(n= 16)
Review results:
Description of studies (Appendix 2):

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ASSIGNMENT 2
Figure 3. Flowchart showing paper selection process
(Source: Author)
Note: The flowchart diagram does not include gathering information from the
government websites.
Results
The quantitative and the qualitative evidence gathered as per the flowchart shown
above shows that the entire collection process would consist of study of several articles. Eight
studies have been conducted in the systematic review with a before after design followed by
three controlled method of clinical trials that have been performed in different healthcare
settings that successfully met the criteria of inclusion. The objective of the study was to find
out the effectiveness of the team communication during clinical handover specifically while
communicating telephonic calls from the nurses to the healthcare professionals. The results in
this context show that the studies were heterogeneous with the accordance to the
characteristics of the study specifically during patient related results. In total 25 different
patient related outcome was measured in the study out which 8 were reported to have shown
some significant improvement.
Systematic process of review
The search of literature were identified amongst 1437 articles from which 482 articles
have been removed for their duplicate contents. In this, 955 articles remained after the
exclusion of the duplicated and unauthentic articles. In this, full articles were retrieved for
further examination, from which 922 were excluded after evaluating their titles and abstracts.
From the remaining 19 articles, all of the articles were completely evaluated in their full text
amongst all these 16 articles were finally included in the review. The AMSTAR score was
seen to be nine. However, several AMSTAR items were not properly reported in the review

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ASSIGNMENT 2
such as exposure of conflicts of interest amongst individual. Moreover, other AMSTAR
components were hardly reported. It has been seen that the AMSTAR rate on the inclusion
was ICC 0.85(90% CI 0.85 to 0.90). However, no additional studies were identified during
screening of the references given in the articles.
Quality evaluation
The ratter agreement on the studies quality was good. In this context, the randomised
controlled trial by Miller et al. (2018) have been rated as the most strong one and the trial by
Ding et al. (2016) has been considered as the moderate one in the above study quality while
the remaining 8 studies were considered to be the weak ones.
These studies were rated as strong in terms of the design and category, specifically
because these studies were controlled clinical trials. In this, the eighth studies have been used
before the study framework resulted in a weak rating in the study design category. Except for
the study conducted by Sassoli & Day (2017), the study did not describe adequate details the
quality of study regarding the selection criteria was seen as moderate. The study by Anderson
et al. (2015), used a design of RCT as a design with and faculty of randomisation unit.
Therefore, for the design of study, the results were controlled for the potential such as
infrastructure, safety of patients, culture and management. However, the main outcome, study
object8ves and application of ISOBAR intervention was described in the study that was not
describe in any of the studies leading to a moderate rating in the classification of controlled
trials. In this context, the reviews that rated that clinical handover outcome were biased in
regards of the interventions,
Overall, there was a lack of reporting on the statistical data and number of
professional trainers Moreover, there were problems in the calculations of sample size in
ensuring the sufficient power have not been reported in any of the studies.

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ASSIGNMENT 2
Discussion:
The integration of information from the industrious analysis of the articles and
primary analysis brings forward certain contradictions. The findings do point out that
appropriate communication plays important role in clinical handover. It has also come to the
forefront that effective clinical handover plays crucial role in ensuring wellbeing of the
patients. The findings also show that the clinical handover in hospitals is governed by laws
and protocol which medical practitioners have to follow in Australia. However, the rising
number of falls of patients, especially aged patients in hospitals actually contradicts the actual
implication of laws in the area (figure 1).
The analysis conducted above has encountered several limitations throughout its
stage of commencement. The first limitation it faced was limitation of time as the scope of
the project was large and requires a longer tenure. However, it had to be completed within a
predetermined time. The second limitation was availability of reliable secondary data. As
shown in the flowchart above, a large number of articled had to be analysed in order to gather
a body of data which is authentic and could be used for the research (figure 1). The third
limitation which the research faced was gaining access to RCT data was not easy. The fourth
limitation was that it was not always possible to interview patients for long time so as not to
put them under stress.
Conclusion:
The above discussion clearly shows that clinical handover based on strong
communication between staff involved is of strong importance as far as patient safety is
concerned. The hospitals in Australia should ensure that there is effective handover of clinical
responsibility and accountability. Clinical handover is not only a functional area of hospital
operations, it has strong ethical aspects as well. The medical staff should be responsible and

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ASSIGNMENT 2
ethical while transferring clinical responsibility. The research can form support for future
research about medical ethics and accountability of medical professionals.
The implications of effective clinical handover would result in faster patient recovery
and lower number of accidents as well as death to the improper clinical handovers. The
research under consideration can encourage future research in fields of nursing and
paramedical profession.
Implications of the practice:
The practice implies that inefficient clinical handovers are still prevalent in hospitals
in Australia. It can also be implied that the intense pressure to treat the ever increasing
number of patients put immense pressure on the medical staff. This implies Australian
medical industry should acquire more medical staff to ensure more efficient patient care.
Implications of the research:
It can be implied from the research that the doctors and nurses should more
responsible while taking clinical handovers. They should to ensure safety and security of
patients.

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ASSIGNMENT 2
References:
Abraham, J., Kannampallil, T. G., Almoosa, K. F., Patel, B., & Patel, V. L. (2014).
Comparative evaluation of the content and structure of communication using two
handoff tools: implications for patient safety. Journal of critical care, 29(2), 11-21.
Aihw.gov.au. (2018). Retrieved from
https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/
indicators-of-australias-health/falls-resulting-in-patient-harm-in-hospitals
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical
handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-
6), 662-671.
Asfaw, B. B. (2015). Demonic Possession and Healing of Mental illness in the Ethiopian
Orthodox Tewahdo Church: the Case of Entoto Kidane-Mihret Monastery. American
Journal of Applied Psychology, 3(4), 80-93.
Ding, M., Bell, A., Rixon, S., Rixon, A., Addae-Bosomprah, H., & Simon, J. (2016).
Effectiveness of educational communication interventions for health professionals to
improve quality of care in emergency departments: a systematic review protocol. JBI
database of systematic reviews and implementation reports, 14(4), 10-19.
Hailemariam, M., Fekadu, A., Selamu, M., Medhin, G., Prince, M., & Hanlon, C. (2016).
Equitable access to integrated primary mental healthcare for people with severe
mental disorders in Ethiopia: a formative study. International journal for equity in
health, 15(1), 121.
Kaye, D. K., Nakimuli, A., Kakaire, O., Osinde, M. O., Mbalinda, S. N., & Kakande, N.
(2015). Gaps in continuity of care: patients’ perceptions of the quality of care during

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labor ward handover in Mulago hospital, Uganda. BMC health services
research, 15(1), 190.
Kitas, G. D. (2015). SP0091 Accuracy of Cardiovascular Risk Algorithms in Rheumatoid
Arthritis and Its Management: Next Steps to a Targeted Approach. Annals of the
Rheumatic Diseases, 74, 23.
Miller, K., Hamza, A., Metersky, K., & Gaffney, D. M. (2018). Nursing transfer of
accountability at the bedside: partnering with patients to pilot a new initiative in
Ontario community hospitals. Patient Experience Journal, 5(1), 90-96.
Perkins, G. D., Griffiths, F., Slowther, A. M., George, R., Fritz, Z., Satherley, P., ... &
Mockford, C. (2016). HEALTH SERVICES AND DELIVERY RESEARCH.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015).
Reducing readmissions using teach-back: enhancing patient and family
education. Journal of Nursing Administration, 45(1), 35-42.
Preiser, J. C., van Zanten, A. R., Berger, M. M., Biolo, G., Casaer, M. P., Doig, G. S., ... &
Laviano, A. (2015). Metabolic and nutritional support of critically ill patients:
consensus and controversies. Critical care, 19(1), 35.
Primdahl, J. (2015). SP0092 How Do Nurses Assess and Manage the Patients' Cardiovascular
Risk? Results From European Studies. Annals of the Rheumatic Diseases, 74, 23.
Redley, B., Botti, M., Wood, B., & Bucknall, T. (2017). Interprofessional communication
supporting clinical handover in emergency departments: An observation
study. Australasian Emergency Nursing Journal, 20(3), 122-130.

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Safetyandquality.gov.au. (2018). Retrieved from https://www.safetyandquality.gov.au/wp-
content/uploads/2012/01/NSQHS-Standards-Fact-Sheet-Standard-6.pdf
Sassoli, M., & Day, G. (2017). Understanding pharmacist communication and medication
errors: A systematic literature review. Asia Pacific Journal of Health
Management, 12(1), 47.
Watson, B. M., Manias, E., Geddes, F., Della, P., & Jones, D. (2015). An analysis of clinical
handover miscommunication using a language and social psychology
approach. Journal of Language and Social Psychology, 34(6), 687-701.
Who.int. (2018). Retrieved from http://www.who.int/bulletin/volumes/92/1/13-134106/en/
Williams, C. L. (2018). A Comparison of the Risks and Benefits of Nursing Bedside Shift
Report vs. Traditional Shift Report: A Systematic Review of the
Literature. International Journal of Studies in Nursing, 3(2), 40.
Yu, M., & ja Kang, K. (2017). Effectiveness of a role-play simulation program involving the
sbar technique: A quasi-experimental study. Nurse education today, 53, 41-47.

Running Head: ASSIGNMENT 2
Appendix:
Appendix 1: JBI Critical appraisal instruments for experimental studies
Author Was the
assignment
to treatment
groups truly
random?
Were
partici
pants
blinde
d to
treatm
ent
allocat
ion?
Was
alloca
tion
to
treat
ment
group
s
conce
aled
from
the
alloca
tor?
Were
the
outco
mes
of
peopl
e
who
with
drew
descr
ibed
and
inclu
ded
in the
analy
sis?
Were
those
assess
ing
outco
mes
blind
to the
treatm
ent
alloca
tion?
Were
the
control
and
treatm
ent
groups
compa
rable
at
entry?
Were
groups
treated
identicall
y other
than for
the named
interventi
ons?
Were
outcomes
measured
in the same
way for all
groups?
Were
outcome
measures in
a reliable
way?
Was
appropria
te
statistical
analysis
used?
Alinier, et al. 1 2 2 2 2 1 1 1 1 1
Brannan, et
al.
1 2 2 2 2 1 1 1 1 1

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ASSIGNMENT 2
Hoffmann, et
al.
1 2 2 2 2 1 1 1 1 1
Howard 1 2 2 1 2 1 1 1 1 1
Jeffries &
Rizzolo
1 2 2 2 2 1 1 1 1 2
Radhakrishn
an, et al.
1 2 2 1 2 1 1 1 1 1
Ravert 1 2 2 1 2 1 1 1 1 1
Schumacher 1 2 2 3 3 1 1 1 1 1
Appendix 3:
AMSTAR
ite
m
Acheampong
Conroy
Dückers
Keers
Kullberg
Kuo
Manias
Manias
Ohashi
Pepper
Raban
Voshall (2013)
Wimpenny, (2010)
Wulff
1. Was an
a
pr
io
ri
de
sig
n
pr
ov
0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 1 1

28
ASSIGNMENT 2
id
ed
?
2. Was
th
er
e
du
pli
ca
te
st
ud
y
sel
ect
io
n
an
d
da
ta
ex
tr
ac
tio
n?
1 0 1 1 0 0 0 1 0 0 1 1 1 1 0 1 0 1 1
3. Was a
co
1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1

29
ASSIGNMENT 2
m
pr
eh
en
siv
e
lit
er
at
ur
e
se
ar
ch
pe
rf
or
m
ed
?
4. Was the
sta
tu
s
of
pu
bli
ca
tio
n
1 1 1 1 1 1 0 1 0 0 1 1 1 1 0 1 0 1 0

30
ASSIGNMENT 2
(th
at
is,
gr
ey
lit
er
at
ur
e)
us
ed
as
an
in
cl
usi
on
cri
ter
io
n?
5. Was a
lis
t
of
st
ud
ies
(in
0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 1 0

31
ASSIGNMENT 2
cl
ud
ed
an
d
ex
cl
ud
ed
)
pr
ov
id
ed
?
6. Were
th
e
ch
ar
ac
ter
ist
ics
of
th
e
in
cl
ud
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

32
ASSIGNMENT 2
ed
st
ud
ies
pr
ov
id
ed
?
7. Was the
sci
en
tifi
c
qu
ali
ty
of
th
e
in
cl
ud
ed
st
ud
ies
as
ses
se
0 0 0 1 0 1 1 1 1 0 1 1 1 0 0 1 0 1 1

33
ASSIGNMENT 2
d
an
d
do
cu
m
en
te
d?
8. Was the
sci
en
tifi
c
qu
ali
ty
of
th
e
in
cl
ud
ed
st
ud
ies
us
ed
ap
0 1 0 1 1 1 1 1 1 0 1 1 1 0 1 1 0 1 1

34
ASSIGNMENT 2
pr
op
ria
tel
y
in
fo
r
m
ul
ati
ng
co
nc
lus
io
ns
?
9. Were
th
e
m
et
ho
ds
us
ed
to
co
m
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

35
ASSIGNMENT 2
bi
ne
th
e
fin
di
ng
s
of
st
ud
ies
ap
pr
op
ria
te
?
10. Was
th
e
lik
eli
ho
od
of
pu
bli
ca
tio
0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0

36
ASSIGNMENT 2
n
bi
as
as
ses
se
d?
11. Was
th
e
co
nfl
ict
of
int
er
est
in
cl
ud
ed
?
1 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1
Total 6 6 6 8 6 9 6 10 6 2* 1 9 8 6 4* 9 3* 10 8
Appendix 4:
Quality scoring Assessment of Multiple Systematic Reviews (AMSTAR) items:

37
ASSIGNMENT 2
AMST
AR
item
Acheampong
Conroy
Dückers
Keers
Kullberg
Kuo
Manias
Manias
Ohashi
Pepper
Raban
Wimpenny, (2010)
Wulff
1. Was
an a
priori
design
provide
d?
0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 1 1
2. Was
there
duplicat
e study
selectio
n and
data
extracti
on?
1 0 1 1 0 0 0 1 0 0 1 1 1 1 0 1 0 1 1
3. Was
a
compre
hensive
literatur
1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1

38
ASSIGNMENT 2
e search
perform
ed?
4. Was
the
status
of
publicat
ion
(that is,
grey
literatur
e) used
as an
inclusio
n
criterio
n?
1 1 1 1 1 1 0 1 0 0 1 1 1 1 0 1 0 1 0
5. Was
a list of
studies
(includ
ed and
exclude
0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 1 0

39
ASSIGNMENT 2
d)
provide
d?
6. Were
the
charact
eristics
of the
include
d
studies
provide
d?
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
7. Was
the
scientifi
c
quality
of the
include
d
studies
assesse
d and
0 0 0 1 0 1 1 1 1 0 1 1 1 0 0 1 0 1 1

40
ASSIGNMENT 2
docume
nted?
8. Was
the
scientifi
c
quality
of the
include
d
studies
used
appropr
iately in
formula
ting
conclus
ions?
0 1 0 1 1 1 1 1 1 0 1 1 1 0 1 1 0 1 1
9. Were
the
method
s used
to
combin
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

41
ASSIGNMENT 2
e the
finding
s of
studies
appropr
iate?
10.
Was the
likeliho
od of
publicat
ion bias
assesse
d?
0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0
11.
Was the
conflict
of
interest
include
d?
1 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1
Total 6 6 6 8 6 9 6 10 6 2* 11 9 8 6 4* 9 3* 10 8