Exploring the impact of an Electronic Medical Record implementation on the quality of nursing handover: a comparative case-study. (Preprint)

<sec> <title>BACKGROUND</title> Ineffective clinical handover has the potential to compromise patient safety and quality of care. Standardising the handover process is a widely adopted improvement strategy intended to reduce failures of information transfer. By enabling real-time access to patient information, Electronic Medical Records (EMRs) could address communication issues inherent to nursing handover. </sec> <sec> <title>OBJECTIVE</title> This case study sought to compare handover occurring at EMR-enabled sites with that occurring at paper-based sites in a single Australian public health service to examine differences in handover quality. </sec> <sec> <title>METHODS</title> A mixed-methods research design was utilised, incorporating an observational audit of 60 handovers and post-handover surveys conducted in both EMR-enabled and paper-based ward environments, allowing analysis between the two cohorts. Quality was measured as compliance against key principles of the organisation’s Clinical Handover Standard and ratings of perceived handover quality from handover recipients. </sec> <sec> <title>RESULTS</title> Overall compliance with the Clinical Handover Standard was comparable. Key differences between the two cohorts included improved bedside handover and patient engagement factors in the paper-based environments, while improved transfer of critical alerts and risks occurred in the EMR-enabled wards both more efficiently and with fewer interruptions. </sec> <sec> <title>CONCLUSIONS</title> The presence of an EMR, particularly the design and functionality of the EMR interface, may act as a barrier to bedside handover, patient engagement in the handover process and the delivery of patient centred care. These barriers require further investigation and targeted solutions. While reported benefits suggest a degree of user acceptance of the EMR, the ongoing reliance on paper-based handover forms indicates a gap where the EMR does not yet adequately support nursing handover. </sec> <sec> <title>CLINICALTRIAL</title> N/A </sec>