Transfer of responsibility and accountability of patient care

Abstract

Objective: This paper reports on a study of clinical incidents related to the transfer of accountability and responsibility of patient care during clinical handover in three major health facilities in regional Australia. It aims to identify significant issues in the area of transferring accountability and responsibility.
Background: Although clinical handover is widely acknowledged as the process which transfers accountability and responsibility, issues occur particularly when this transfer is incomplete, shared or when one clinician feels an ongoing sense of responsibility for the patient.
Methods: A thematic analysis of incidents related to clinical handover was conducted on data collected at three regional settings within Australia in order to identify issues which had occurred during this process. The Incident Information Management System (IIMS) is a database that collects information about clinical incidents and near misses and relies on health staff to report them. The initial information retrieved from IIMs identified 3716 possible events for inclusion. A thematic analysis was undertaken of the data which identified transfer of responsibility and accountability as a key theme.
Results: The data related to the transfer of responsibility and accountability came to prominence in the incident reports in three ways. These included; identifying omissions, issues with information exchange and refusal to accept responsibility of care.
Conclusions: This study demonstrates the need for a more systematic approach regarding communication between health professionals regarding the transferability and accountability of patient care.
Relevance to clinical practice: Clinical handover remains a contentious issue regarding patient care and safety. Health professionals may benefit from this review of incidents related to clinical handover and consider some of the recommendations to improve clinical practice.