DR MARY DAHM Research Fellow, Australian Institute of Health Innovation, Macquarie University
DR CARMEL CROCK Director, Emergency Department, The Royal Victorian Eye and Ear Hospital
Stop hiding the uncertainty A grassroots approach to creating a culture of openness in Emergency Departments.
Uncertainty at handover time
up to 51% of patients may be misdiagnosed in ED
Handovers in an emergency department (ED)
(see Graber 2013, The incidence of diagnostic
from one clinical team to the next often occur
error in medicine).
in a rushed and pressured environment. Time
Misdiagnoses in ED have been associated with
and resources are limited, test results can be
communication factors such as inadequate
delayed and admission rates hard to manage,
handover, and systems factors including excessive
all of which may contribute to uncertainty at
workload and clinician fatigue. These factors are
the time of handover.
exacerbated during night shifts where clinicians
While it is tempting to hide this uncertainty,
have even fewer system resources, and where
studies have shown it can contribute to errors in
fatigue is likely to affect clinical performance,
diagnosis and poorer outcomes for the patient and
thus contributing to an environment that is
the clinical teams. Although the overall incidence
conducive to diagnostic errors. Morning handovers,
of diagnostic error in EDs is unknown, for certain
therefore, are crucial patient safety checkpoints,
conditions, such as subarachnoid haemorrhage,
as care and knowledge about patients is transferred from night to day staff.
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The Health Advocate • OCTOBER 2019
