Table 2 Themes identified during thematic analysis
From: Patient perspectives on surgical handover quality: a mixed-methods survey
Theme | Subtheme | Example quote |
|---|---|---|
The impact of poor interprofessional communication | Patients needing to repeat themselves | “I gave my history about seven times - could there be a more streamlined way?” – Respondent 95 |
Patients receiving contradicting information | “i got told different things by everybody who dealt with me if i was told anything at all” – Respondent 108 | |
Patient distress | “I also had one doctor on the surgical team discuss a surgery with another patient beside me and while explaining the risks of the surgery reassured the patient that he wouldn't "get stuck with a colostomy bag". I was the next patient to be seen and have a permanent ileostomy. I found this very insensitive of the doctor and I'm not sure if this was because he hadn't had my details handed over yet or if he just chose his words very poorly but I found this very distressing.” – Respondent 75 | |
Staff miscommunication | “Often the nursing staff are passing on messages from the medical team and often the message is interpreted incorrectly. The nursing staff don’t understand/communicate rationale for decisions.” – Respondent 60 | |
Patients needing to correct misinformation | “As a patient I feel you have to be very knowledgeable about your condition, have basic medical knowledge and correct all medical staff when they state incorrect information which happened during my visit. I have confidence to correct people but I would be very concerned about vulnerable people who don’t speak up for themselves” – Respondent 60 | |
Poor staff knowledge of patients | “I’m also concerned that important and pertinent information regarding my symptoms & medical history was not written down or shared correctly with new doctors.” – Respondent 60 | |
Delayed or premature discharge | “I was discharged I feel prematurely. The doctor covering my care was not part of the team I believe and failed to check a drain I had attached which was not working correctly This in my view has led to complications.” – Respondent 105 “I found because I was in hospital over the bank holiday I was kept in lounger as my own consultant were not in” – Respondent 93 | |
Delayed treatment or medication | “I felt like I was constantly repeating myself, at one stage 3 different people were asking me about an underlying condition that delayed my surgery yet I had let them know this from the start.” – Respondent 146 “There was sometimes a delay in treatment from the nurses for dressing changes or iv meds, which would on more than one occasion meant a dose of antibiotics were missed or a dressing unchanged for hours longer than acceptable.” – Respondent 115 | |
Incomplete tasks | “Poor lack of communication. One doctor would say something but because it was not documented in my chart they would not do it” – Respondent 188 | |
Worsening of symptoms | “..but they put me on St. John's discharge unit (while waiting to transfer to a ward) in a chair for 7 hours, I couldn't sit, I told them this begore they moved me. The staff in John's put me on the resus trolley as I was in agony on the chair, I needed to lie on my side. This was incredibly distressing for such a long period of time also. The nurse in John's unit told me I should complain through PALS. She had contacted my surgical team to come and review me as I was in so much pain. No one came. When I mentioned it to my consultant the next day he shrugged and said "I never said you were able to sit". I had told them before I left [A&E]” – Respondent 146 | |
Prolonged ward rounds | “Every time there was a new doctor, I had to give an explanation of my history or else they took ages to look through the details in the medical folder in front of my with a big team of people when they came to check on me each morning” – Respondent 81 | |
The importance of teamwork amongst staff | A collaborative approach to patient management | “The orthopaedic and plastic teams came up with different solutions but eventually [agreed on] the correct one for me.” – Respondent 39 “All doctors acted as one team with key goal getting me well, monitoring my progress and creating a clear recovery plan.” – Respondent 135 |
Adequate staff knowledge of patients | “Everyone I spoke to on the weekend knew what was going on and I didnt need to really explain anything to anyone.” – Respondent 159 | |
External factors impacting handover effectiveness | A lack of an electronic patient record | “When I was being admitted I was asked had I been here before- I had numerous surgeries in the hospital but my file hadn't been located” – Respondent 75 “..information created should be digital too much paper work can sometimes lead to mistakes” – Respondent 135 |
A lack of staff availability around handover time | “Not enough nurses and doctors so it’s pass the buck when it comes to handover” – Respondent 23 | |
Accuracy of written handover | “I’m also concerned that important and pertinent information regarding my symptoms & medical history was not written down or shared correctly with new doctors.” – Respondent 60 | |
The impact of the weekend | “Felt like everything was a bit slower to progress on the weekends. Feels like you are waiting on your Dr and surgeon to come back to work to get any MRI/ops etc booked in.” – Respondent 137 “I found because I was in hospital over the bank holiday I was kept in longer as my own consultant were not in” – Respondent 93 | |
Patients taking a passive approach to their care | “They should just do what they do, I have no interest in a handover being explained to me.” – Respondent 155 “The doctors knew what they were doing, I dont think they would ever make a mistake. I trust them and it does me no good to be worrying about them making mistakes. I just want to get better and leave it all to them” – Respondent 157 |