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This study evaluated the effectiveness of virtual reality (VR) simulation training in enhancing emergency room (ER) nurses' preparedness for air-to-ground patient handoff and psychological safety, defined as participants' perceived confidence and comfort within the training environment. Aeromedical transport is critical in regions with complex terrain or limited resources. The reception phase poses time-sensitive and environmental challenges, and insufficient training increases the risk of handoff errors and patient harm. Existing programs focus mainly on in-flight care, with little attention to reception. VR offers an immersive, standardized, and safe platform for reception training. A quasiexperimental design using a nonrandomized, sequential cohort allocation by training date with two-group repeated measures was employed. Seventy-six emergency nurses from a northern Taiwan medical center were assigned by training date to a traditional drill group (  = 33) or a VR simulation group (  = 43). The \"H.A.N.D.O.F.F.\" curriculum, based on the 2024 CDC air-to-ground handoff protocol, was implemented. Outcomes included the Air-to-Ground Patient Handoff Preparedness Inventory and Psychological Safety Scale. Data were collected at baseline, postintervention, and 8 weeks and analyzed using generalized estimating equations. Baseline score refers to participants' initial preparedness prior to the intervention, and no significant differences were found between groups at baseline ( > 0.05). Postintervention, the VR group reported significantly higher preparedness and psychological safety than controls ( < 0.001), and these improvements were sustained at the 8-week follow-up ( < 0.001). This study demonstrated that VR simulation significantly improves preparedness for air-to-ground patient handoff, highlighting its practical value. Future applications may extend to military, police, and fire departments to foster interprofessional collaboration and enhance emergency response capabilities.

BackgroundHandoffs are a weak link in the chain of clinical care of inpatients. Within-unit handoffs are increasing in frequency due to changes in duty hours. There are strong rationales for standardising the reporting of critical information between providers, and such practices have been adopted by other industries.ObjectivesAs part of Making Healthcare Safer IV we reviewed the evidence from the last 10 years that the use of structured handoff protocols influences patient safety outcomes within acute care hospital units.MethodsWe searched four databases for systematic reviews and original research studies of any design that assessed structured handoff protocols and reported patient safety outcomes. Screening and eligibility were done in duplicate, while data extraction was done by one reviewer and checked by a second reviewer. The synthesis of results is narrative. Certainty of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation framework as modified for Making Healthcare Safer IV.ResultsWe searched for evidence on 12 handoff tools. Two systematic reviews of Situation, Background, Assessment, Recommendation (SBAR) (including 11 and 28 original research studies; 5 and 15 were about the use in handoffs) and two newer original research studies provided low certainty evidence that the SBAR tool improves patient safety outcomes. Ten original research studies (about nine implementations) provided moderate certainty evidence that the I-PASS tool (Illness severity, Patient summary, Action list, Situation awareness, Synthesis to receiver) reduces medical errors and adverse events. No other structured handoff tool was assessed in more than one study or one setting.ConclusionThe SBAR and I-PASS structured tools for within-unit handoffs probably improve patient safety, with I-PASS having a stronger certainty of evidence. Other published tools lack sufficient evidence to draw conclusions.PROSPERO registration numberCRD42024576324.

ABSTRACT Objectives: to aimed to explore patient handoff practices among nursing teams in hemodialysis clinics. Methods: this study was conducted from April to June 2022, in six hemodialysis clinics in five health regions in Ceará, Brazil. The study involved 44 in-depth individual interviews with nursing professionals. Interviews occurred from April to June 2022 and were recorded for subsequent transcription. Results: four themes emerged from the data analysis: Information communicated during patient handoff; Failures in patient handoff; Communication-enabling technologies; and Nursing team’s perceptions on patient handoff. Final Considerations: the findings indicate that the patient handoff practices in hemodialysis clinics lack standardization and require improved communication among the nursing team. The lack of uniformity in information transmitted during shift handoffs poses a potential risk to patient safety and requires attention to enhance communication protocols. RESUMO Objetivos: explorar as práticas de transferência de pacientes entre as equipes de enfermagem em clínicas de hemodiálise. Métodos: o estudo foi realizado de abril a junho de 2022, em seis clínicas de hemodiálise em cinco regiões de saúde no Ceará, Brasil. O estudo envolveu 44 entrevistas individuais em profundidade com profissionais de enfermagem. As entrevistas ocorreram de abril a junho de 2022 e foram gravadas para posterior transcrição. Resultados: quatro temas emergiram da análise dos dados: Informações comunicadas durante a transferência de pacientes; Falhas na transferência de pacientes; Tecnologias facilitadoras da comunicação; e Percepções da equipe de enfermagem sobre a transferência de pacientes. Considerações Finais: os resultados indicam que as práticas de transferência de pacientes em clínicas de hemodiálise precisam de padronização e requerem melhor comunicação entre a equipe de enfermagem. A falta de uniformidade nas informações transmitidas durante as transferências de turno representa um risco em potencial para a segurança do paciente e requer atenção para aprimorar os protocolos de comunicação. RESUMEN Objetivos: explorar las prácticas de traspaso de pacientes entre los equipos de enfermería en las clínicas de hemodiálisis. Métodos: estudio realizado entre abril y junio de 2022 en seis clínicas de hemodiálisis de cinco regiones de salud de Ceará (Brasil). El estudio consistió en 44 entrevistas individuales en profundidad con profesionales de enfermería. Las entrevistas se realizaron entre abril y junio de 2022 y se grabaron para su posterior transcripción. Resultados: del análisis de los datos surgieron cuatro temas: Información comunicada durante el traspaso de pacientes; fallos en el traspaso de pacientes; tecnologías que facilitan la comunicación; y percepciones del equipo de enfermería sobre el traspaso de pacientes. Consideraciones Finales: los resultados indican que las prácticas de traspaso de pacientes en las clínicas de hemodiálisis son poco estandarizadas y requieren una mejor comunicación entre el equipo de enfermería. La falta de uniformidad en la información transmitida durante los traspasos de turno supone un riesgo potencial para la seguridad del paciente y requiere atención para mejorar los protocolos de comunicación.

Background General practitioners (GP) and community pharmacists need information about hospital discharge patients’ medicines to continue their management in the community. This necessitates effective communication, collaboration, and reliable information-sharing. However, such handover is inconsistent, and whilst digital systems are in place to transfer information at transitions of care, these systems are passive and clinicians are not prompted about patients’ transitions. There are also gaps in communication between community pharmacists and GPs. These issues impact patient safety, leading to hospital readmissions and increased healthcare costs. Methods A three-phased, multi-method study design is planned to trial a multifaceted intervention to reduce 30-day hospital readmissions. Phase 1 is the co-design of the intervention with stakeholders and end-users; phase 2 is the development of the intervention; phase 3 is a stepped wedge cluster randomised controlled trial with 20 clusters (community pharmacies). Expected intervention components will be a hospital pharmacist navigator, primary care medication management review services, and a digital solution for information sharing. Phase 3 will recruit 10 patients per pharmacy cluster/month to achieve a sample size of 2200 patients powered to detect a 5% absolute reduction in unplanned readmissions from 10% in the control group to 5% in the intervention at 30 days. The randomisation and intervention will occur at the level of the patient’s nominated community pharmacy. Primary analysis will be a comparison of 30-day medication-related hospital readmissions between intervention and control clusters using a mixed effects Poisson regression model with a random effect for cluster (pharmacy) and a fixed effect for each step to account for secular trends. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p , registered 19 April 2024.

Background Nursing internship students often lack the necessary clinical decision-making skills, confidence, and experience due to limited competence. To ensure safe and high-quality care, nursing faculty must train graduates with the self-efficacy required to make effective decisions in complex, dynamic, and high-stress healthcare environments. The handover process involves the information that plays a critical role in clinical decision-making and care planning. One of the frameworks used in handover process is ISBAR (Identification, Situation, Background, Assessment, Recommendation). The clinical supervision model serves as an educational and supportive approach aimed at enhancing self-efficacy and skills, including the use of handover. Objective This study aimed to investigate the impact of an ISBAR-based Clinical Supervision Model (CSM) during handover on clinical decision-making and self-efficacy in nursing internship students. Method This quasi-experimental, two-group (pre-test and post-test) study was conducted in selected hospitals affiliated with Isfahan University of Medical Sciences, Iran, in 2024. Participants were selected through convenience sampling and then randomly allocated to either the intervention or control group. Data were collected using the ISBAR communication checklist, the Self-Efficacy in Clinical Performance (SECP) questionnaire, the Clinical Decision-Making questionnaire, and the Manchester Clinical Supervision Scale (MCSS). The clinical supervision model and routine supervision were administered over six sessions for the intervention and control groups, respectively. Data were analyzed using SPSS version 16. Independent t-tests and chi-square tests were used to assess baseline differences between groups. Paired t-tests evaluated within-group changes in clinical self-efficacy and clinical decision-making scores. ANCOVA was applied to compare ISBAR communication scores across six time points and post-intervention clinical self-efficacy and decision-making scores, controlling for pre-intervention values. Repeated measures ANOVA assessed within-group changes in mean ISBAR scores over time, while MANOVA examined multiple, interrelated ISBAR subscale scores. A significance level of p  < 0.05 was set for all analyses. Results There were no significant differences in baseline characteristics between the intervention and control groups ( p  > 0.05). According to the within-group analysis, changes in the ISBAR communication scores over time were significant in both the intervention and control groups (p Time < 0.001), with a greater increase observed in the intervention group (p Intervention < 0.001). The intervention group demonstrated a significant improvement in clinical decision-making ( p  < 0.001) compared to the control group. Clinical self-efficacy showed significant improvement in both the control and intervention groups after the intervention ( P  < 0.05). However, between-group analysis showed that the increase was higher in the intervention group than in the control group ( P  < 0.001).) The mean score of the Manchester questionnaire in the intervention group in this study was 130.30, reflecting the high impact of implementing the clinical supervision model. Conclusion The findings revealed that the use of the clinical supervision model based on the ISBAR framework led to improvements in clinical self-efficacy and clinical decision-making, alongside the enhancement of handover skills in nursing internship students. Therefore, it is recommended that this model be utilized in the education of nursing students and newly graduated nurses to ensure safe and high-quality care.

ABSTRACTThe purpose of this study was to develop a standardized hand-off program based on the SWITCH tool (surgical procedure, wet, instruments, tissue, counts, have you any questions?) and to examine its effectiveness in terms of self-reported perceptions of hand-off satisfaction, self-efficacy, surgical nursing performance, and communication competence among OR staff members. This randomized controlled trial used a nonsynchronized control group with a pretest and posttest design. The nurses in the experimental group received one educational session and used the standardized hand-off tool for four weeks. The control group performed hand offs using the usual method rather than a tool. After the intervention, self-reported hand-off satisfaction ( P = .001), self-efficacy ( P = .005), and surgical nursing performance ( P < .001) scores were significantly higher in the experimental group than in the control group. A standardized hand-off tool can improve nurse perceptions of satisfaction, self-efficacy, and surgical nursing performance.

Background Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. Objective The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. Methods A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data. Results The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process. Conclusions Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients’ and families’ capabilities, needs and preferences. Future interventions should be directed at healthcare providers’ attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

OBJECTIVEThe objective of this study is to assess benefits of the acuity-adaptable (AA) care model in rural hospitals. BACKGROUNDThe AA model aims to provide care in the same space from admission to discharge regardless of acuity. Evidence is lacking to support claims that AA care will improve patient safety, increase nurse productivity, and improve patient/staff satisfaction in rural hospitals. METHODSPatients admitted to a rural intensive care unit (ICU) were allocated to an AA group or an ICU group. Patients in the AA group remained in the ICU room through discharge. Patients in the ICU group transferred out of ICU when acuity permitted. Patient anxiety, depression, and perception of emotional care were measured. Staff responses were assessed qualitatively. RESULTSAcuity-adaptable patients reported significantly more anxiety and less perceived emotional care than ICU patients. Intensive care unit nurses resisted caring for less acute patients. CONCLUSIONDisadvantages may outweigh benefits of AA care delivery in the rural ICU.

Background Timely and accurate discharge medicine information is essential for primary care clinicians, including general practitioners and community pharmacists, to provide safe and effective post-discharge care. Inadequate handover of discharge medicines poses risks of medication-related harm, compromising patient safety and leads to hospital readmissions. This study aimed to develop a multifaceted intervention targeting older patients (>65 years) to enhance medicine handover at hospital discharge. Methods Following an initial consensus-building workshop, a structured five-step co-design process was implemented. Step 1 involved workshops and interviews with hospital clinicians, hospital leadership, primary care providers, and consumers experienced in discharge medicine handover. Stakeholder input in Step 2 refined intervention components and developed training materials. Step 3 obtained endorsement from health service decision makers and governance approvals. Step 4 included pharmacist upskilling, end-user testing, and feedback collection. Step 5 finalised intervention components and constructed a Logic Model. Results Seventy-eight stakeholders participated in workshops and interviews from August to November 2023. Four key medicine handover objectives for older patients emerged, which were operationalised into intervention recommendations over a five-month period (December 2023-April 2024). Component 1 empowered patients to query clinicians about their medications via a dedicated website with a question builder and evidence-based resources. Component 2 involved training doctors to document reasons for medicine changes in patient records. Component 3 implemented patient risk stratification to guide tailored strategies for communication to primary care clinicians. Component 4 focused on discharge reconciliation planning by unit pharmacists in collaboration with physicians. End-user testing yielded positive feedback. Conclusions A co-designed multifaceted intervention was developed to enhance medicine handover during hospital discharge. The intervention will undergo feasibility testing to assess its impact on reducing medication-related harm and hospital readmissions.