| dc.description.abstract | The transference of care (handoff or handover) consists in temporarily or permanently
transferring the responsibility of the patient care to another person or group of
professionals. The objective of this study was to analyze the transfer of patient care in
the daily life of healthcare professionals of an emergency room and its influence on the
quality of care. This is a case study of a qualitative nature, referenced on the daily life
of Michel de Certeau's, especially regarding the concepts of tactics and strategy. We
conducted the study in an emergency room of a large public hospital, located in the
municipality of Belo Horizonte, Minas Gerais, Brazil. Thirty professionals of the
emergency room among physicians, nurses, nursing technicians, stretcher bearer,
social workers, psychologists, and dental surgeons (PS) directly involved in the
transfer of patient care partook of the study. We collected the data through individual
interviews using a semi-structured script, observation, and documentary analysis. We
used the data saturation criterion to close the interviews recorded, transcribed, and
submitted to the Thematic Content Analysis. The data collection occurred after the
approval of the project by the Ethics Committee of the UFMG (COEP/UFMG) and the
Committee of Ethics and Research of the hospital under the decision no 1,519,784 and
1,559,717, respectively. The participants signed the Term of Free and Clarified
Consent (TFCC). The results were organized in five thematic categories:
"Understanding the perspective of the professionals of an emergency room on the
transfer of patient care: multiple perspectives"; "Effective communication: strategies
and tactics experienced in the daily life of the professionals"; "Factors that interfere in
teamwork and communication during a handover"; "Teamwork in the daily life of the
professionals and reflexes on the handover"; "Care centered on the patient and family".
The data revealed aspects of the daily life of the ER, as well as the profile of the
interviewees, subjects who, besides the established norms, use tactics to overcome
difficulties and show commitment to the assistance. The handover is understood in
different ways by the professionals and is more closely connected to the transfer of
information. However, there is also a concern for the transfer of responsibilities and
care continuity. We identified strategies to define the flow of care and standardize the
handover, highlighting the Manchester protocol, electronic medical record, Situation-
Background-Assessment-Recommendation (SBAR), and passometer, as well as
tactics (the real acting) revealed by the professionals. Mild skills such as assertiveness,
listening, and negotiation are shown as tactics to increase the effectiveness of
communication. The nurse appears as a critical piece for the work of the multiprofessional
team and handover organization. We identified factors related to the
environment, structure, processes, and individuals that interfere in the communication
and teamwork during the handover. Teamwork in the ER is perceived more as a
grouping than integration, impairing the handover. Care is performed according to the
standards and definitions of the professionals based more on the hospital´s reality and
less on the needs of the patients and their family, which compromises patient handover
and the safety of this setting. Keywords: Patient Responsibility Transfer. Patient Care
Team. Emergency Medical Services. Patient safety. | |
