Northumbria Research Link Citation: Shapiro, Ethan (2020) A video analysis of clinical handovers between ambulance services and emergency departments. Doctoral thesis, Northumbria University. This version was downloaded from Northumbria Research Link: http://nrl.northumbria.ac.uk/id/eprint/44042/ Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University’s research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: http://nrl.northumbria.ac.uk/pol i cies.html A video analysis of clinical handovers between ambulance services and emergency departments Ethan Shapiro PhD 2020 2 A video analysis of clinical handovers between ambulance services and emergency departments Ethan Shapiro A thesis submitted in partial fulfilment of the requirements of the University of Northumbria at Newcastle for the degree of Doctor of Philosophy Research undertaken in the Faculty of Health and Life Sciences 2020 3 Abstract This thesis examines how clinical handovers between ambulance and emergency services were conducted. Clinical handovers are an exchange of patient information and responsibility from one healthcare team to another. They have been a key area of concern due to potential patient safety issues arising through non-technical human factor skills of communication and teamworking. However, there remains a lack of research that has examined clinical in the context of multidisciplinary settings. To redress this gap in knowledge this thesis adopted a video analysis methodology of pre- existing handover videos. Data was derived from television programs and provided naturally occurring instances of handovers being conducted. The video analysis approach was underpinned by conversation analysis, which allowed an examination of interactional features used by team members to structure handover activity. The three analytical chapters that make up this thesis how the handover activity was carried out: 1) the clinical handover structure, 2) epistemic knowledge claims, and 3) embodied actions. Overall the findings illustrated the different conversational tools used by interdisciplinary team members which shaped how information was communicated. It showed how speakers would use resources to develop engagement during discussions that aided the handover process. This showed that the handover went beyond a structured institutionally derived activity, but one shaped by the interactants This thesis has added to the knowledge of how the interactional order of clinical handovers predominate irrespective of the continuous attempts to standardize the activity. These findings showed how handovers are carried out through an analytical lens of “work as done” 4 rather than “work as imagined” providing understandings that can inform practice and shape future research directions. 5 List of Contents ABSTRACT ................................................................................................................................................. 4 LIST OF CONTENTS ................................................................................................................................. 6 LIST OF FIGURES ..................................................................................................................................... 9 LIST OF TABLES ....................................................................................................................................... 9 ACKNOWLEDGEMENTS ........................................................................................................................ 10 DECLARATION ........................................................................................................................................ 11 INTRODUCTION ...................................................................................................................................... 12 CHAPTER 1: THE CLINICAL HANDOVER ........................................................................................... 16 1.0 INTRODUCTION ................................................................................................................................. 16 1.1 BACKGROUND ................................................................................................................................... 16 1.1.1 THE UK NATIONAL HEALTH SERVICE CONTEXT ..................................................................................... 17 1.1.2 INTERPROFESSIONAL EDUCATION ............................................................................................................ 19 1.2 HANDOVER DELAYS ......................................................................................................................... 22 1.3 NON-TECHNICAL HUMAN FACTORS SKILLS .............................................................................. 25 1.3.1 WORK AS IMAGINED VS. WORK AS DONE ............................................................................................... 27 1.4 LITERATURE SEARCH STRATEGY ................................................................................................ 30 1.5 COMMUNICATION ............................................................................................................................ 32 1.5.1 INFORMATION GAPS ................................................................................................................................ 33 1.5.2 VERBAL OR WRITTEN COMMUNICATION? ............................................................................................... 34 1.5.3 CHAOS IN THE EMERGENCY DEPARTMENT .............................................................................................. 36 1.6 INTERPROFESSIONAL TEAMWORKING ...................................................................................... 39 1.6.1 PROFESSIONAL BOUNDARIES ................................................................................................................... 40 1.6.2 THE ORGANIZATIONAL CULTURE ............................................................................................................ 42 1.6.3 SHARED UNDERSTANDING ....................................................................................................................... 43 1.7 THE STANDARDIZATION OF HANDOVERS .................................................................................. 44 1.7.1 THE STRUCTURED APPROACH .................................................................................................................. 45 1.7.2 THE EFFECT OF STANDARDIZATION ......................................................................................................... 50 1.8 CHAPTER SUMMARY ....................................................................................................................... 53 CHAPTER 2: METHODOLOGY .............................................................................................................. 56 2.0 INTRODUCTION .......................................................................................................................................... 56 2.1 THE USE OF VIDEO-BASED RESEARCH ........................................................................................ 56 2.1.1 NATURALLY OCCURRING DATA ............................................................................................................... 60 2.2. THE HISTORICAL CONTEXT OF CA ............................................................................................. 61 2.2.1 SACKS AND THE DEVELOPMENT OF CA ................................................................................................... 63 2.3 DATA COLLECTION .......................................................................................................................... 64 2.3.1 TYPES OF DATA COLLECTED ......................................................................... ERROR! BOOKMARK NOT DEFINED. 6 2.3.2 ETHICAL CONSIDERATIONS ..................................................................................................................... 71 2.4 TRANSCRIPTION AND ANALYSIS .................................................................................................. 71 2.4.1 TURN-TAKING ......................................................................................................................................... 75 2.4.2 SEQUENCE ORGANISATION ...................................................................................................................... 77 2.4.2.1 Adjacency pairs .............................................................................................................................. 78 2.4.3 REPAIR .................................................................................................................................................... 79 2.5 OTHER KEY AREAS OF INTEREST IN CA ....................................................................................