Doctors' Handovers in an Acute Medical Assessment Unit: A Hierarchical Task Analysis

Abstract

Doctors' shift handovers have not been well documented, so handovers in an acute medical assessment unit (AMAU) were examined by conducting a hierarchical task analysis (HTA). To construct the HTA, activities doctors engaged in pre-handover, during handover, and post-handover were observed. Interviews and a focus group were also conducted to create the HTA. Findings showed that there are critical tasks that should be completed at each phase of the handover process. But these were sometimes omitted, especially in the pre-handover stage, resulting in extended or delayed handover meetings. Doctors believed that various safety nets were in place to catch any omitted information. Post-handover activities involved prioritizing tasks. However, doctors who had received handover believed that their period of responsibility and accountability for transferred patients was likely to be too short, and therefore expressed that prioritizing tasks for every patient was inefficient. Future research should examine handovers in the context of organizational resilience, and include other clinical staff that influence the information provided at handover.