Non-formal patient handover education for healthcare professionals: a scoping review

Objective: The objective of this scoping review was to identify, organize and present the underpinning learning theories, theoretical frameworks, didactics, content and evaluation methods used in existing literature on non-formal patient handover learning programs for healthcare professionals to highlight existing gaps in evidence. Introduction: Clinicians are aware that the professional patient handover between healthcare settings poses a safety risk for patients. Learning programs for healthcare professionals improve patient handovers; however, there has been little formal exploration of the content of patient handover learning programs that elicit efficacious, non-formal learning activities. This scoping review therefore sought to investigate the concept of non-formal patient handover learning. Inclusion criteria: This scoping review considered studies that included healthcare professionals from any healthcare profession examining non-formal patient handover learning in a variety of settings. Both qualitative and quantitative studies, as well as conference abstracts and reviews, were considered. Methods: An extensive search of multiple databases was undertaken. We considered studies published from 2000 onwards in English, Norwegian, Swedish and Danish. Data extraction was undertaken using an extraction tool developed specifically for this scoping review. The results of the review are presented in narrative form supported by tables. Results: Fourteen studies were included. Study populations mostly comprised nurses or inter-professional groups of healthcare professionals, and non-formal learning program evaluation was performed in the context of intra-hospital handover, handover between hospital and other healthcare settings, and handover in the provision of pre-hospital and emergency services. Non-formal patient handover learning programs lacked reporting on the use of underpinning learning theory. The content of handover learning programs was informed by theoretical frameworks, checklists, mnemonics and frameworks developed based on observations in clinical practice or expert knowledge. Regardless of the type of handover, communication was the most-reported theme. The most-reported didactic was simulation. Pre- and post-intervention evaluation was the most-reported design. Evaluation methods varied from questionnaires and tests to observations and thematic analysis. Outcomes were reported on level 1-3, using Kirkpatrick's hierarchical model. No studies reported on patient outcomes. Conclusions: Gaps in knowledge were identified in the limited number of studies, comprising lack of transparency in the design of patient handover learning programs, notably concerning underpinning learning theories and learning objectives, lack of studies covering multiple settings, lack of knowledge regarding the impact of time on learning, lack of studies of any long-term impact, and lack of studies reporting on patient outcomes. Further research on non-formal handover learning programs is needed to enhance the transparency of program design and coherence in use of educational components from underpinning learning theories to evaluation methods. Few studies manage to document outcomes at the patient level.