A national survey of medical morning handover report in Australian hospitals

There is currently heightened interest and focus on ensuring adequate clinical handover between after-hours and day personnel in hospitals, as instanced by the recent publication of Australian Medical Association guidelines on the subject.1

We recently reported on the implementation of medical morning handover report (MMHR) at Launceston General Hospital.2 Canberra Hospital reported similar experience with morning handover.3 As we believed the use of MMHR was not common in Australia,3-7 we decided to conduct a survey of Australian hospitals accredited by the Royal Australasian College of Physicians (RACP) to investigate whether MMHR is commonly practised and define the format used. We report here the results of our survey.

At the time of our survey, in 2005, we identified from the RACP website 76 Australian hospitals accredited for basic physician training (BPT).8 A questionnaire was faxed to the director of BPT at each hospital (as identified from the RACP website), and a return fax number and mailing address were provided. Within 4 weeks, all hospitals were faxed a reminder letter.

Survey responses were returned anonymously. The questionnaire9 sought data on the prevalence and format of MMHR. We also requested information on the hospital’s level of RACP accreditation for BPT; its Rural, Remote and Metropolitan Areas (RRMA) classification;10 and the state or territory in which the hospital was located.

Returned data were manually coded, and statistical analysis was performed using Stata software version 9.2 (StataCorp, College Station, Tex, USA). The association between the use of MMHR and hospitals’ RRMA classification and the trend associations between level of RACP accreditation (treated as a rank-order variable) and use of MMHR were estimated by logistic regression. Results were expressed as odds ratios (ORs).

Of the 76 hospitals invited to participate in our survey, 53 returned questionnaires (a response rate of 70%). Overall, 27 of 1590 possible responses to questions (1.7%) were illegible or not provided. This accounts for the different denominators in some data. Of the 53 respondent hospitals, 31 (58%) reported using MMHR.

The prevalence of MMHR in the 53 responding RACP BPT-accredited hospitals was relatively low, at 58%. Level 3 RACP-accredited and RRMA 1 hospitals were the most likely to use MMHR.

A limitation of our study is that the questionnaires were only distributed to hospitals listed as accredited for BPT on the RACP’s website.8 Hence, non-accredited hospitals and, potentially, some smaller rural and regional hospitals would not have been included. This could have resulted in an overestimation of participation rates in MMHR. Another limitation of our survey is that, by surveying the directors of BPT at each hospital, we included MMHR related to internal medicine and excluded such areas as emergency medicine and surgery.

The low rate of use of MMHR is not in keeping with recently published Australian Medical Association guidelines1 or with RACP accreditation requirements that a consultant-led clinical handover should be conducted.10 An increased commitment to this quality activity is required. One way of encouraging hospitals to conduct MMHR would be to link this to other accreditation procedures, such as those of the Australian Council on Healthcare Standards and the Confederation of Postgraduate Medical Councils.