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EU Health Care Context



Research has shown that, in the Netherlands alone, 30.000 patients suffer preventable harm during treatment each year. According to Wagner et al. (2007) there were 1.735 potential avoidable deaths in 2004 and 1960 potential avoidable deaths in 2008 (Wagner et al, 2010). (Please note, this was not a statistically significant increase). The financial costs of avoidable adverse events, due to re-admissions, longer hospital stays and additional treatment are estimated to be €167 million a year; 1% of a hospital’s total budget, Imagine the magnitude of potential avoidable deaths for the entire EU and the enormous financial damage that is associated with it!

Estimates differ, but it is believed that 25-40% of these adverse events relate to communication and handovers. Several explanations can be offered. For instance, one critical aspect of patient care is continuity of care, but with multiple provider involvement, (from referral to a hospital by a primary care specialist to discharge from the hospital and all caregivers in between), continuity is not a given. Any incomplete handover can lead to adverse events for patients, which may ultimately lead to either life threatening situations during treatment/surgery or prolonging treatment and/or re-hospitalizations after the patient is discharged. When handovers within a clinical setting and between colleagues are already hard to manage,  handovers from primary care to secondary/tertiary care or vice versa may be even more so. Additionally, vulnerable groups such as the elderly, the very young and high-risk patients with multiple co-morbidities run an ever greater risk.

Secondly, care teams are fragmented due to resident work hour regulations and care providers working part-time. As patients, especially those with chronic medical issues, enter the inpatient realm of care (i.e., inside the hospital in contrast to outpatient / outside the hospital), they are often bewildered at the rapidity with which care is instituted. They are disoriented by the lack of a familiar decision-making guide; their primary care physicians. These abrupt shifts in care delivery are compounded by the fact that these patients often have complex co-morbidities and sometimes low health literacy, making them exceedingly vulnerable to the fast-paced transitions in care.

Creating an effective model of communication between inpatient and primary care physicians during times of patient transition, can positively influence a number of domains, including the assurance of patient safety, a patient-centered focus of healthcare delivery, and allocation and use of healthcare re-sources. Although recent literature suggests that primary care physicians are currently not satisfied with communication at transition points between ambulatory and inpatient care settings and that such communications are fraught with content omissions and not performed in a timely fashion, no work to date has outlined a content-driven strategy for improving and standardizing communication during these transitions.

Lastly, handovers are numerous. They take as many forms as there are handover scenarios. In guiding our assumption that there is a need for standardized basic elements in handover processes, we need to identify what aspects of handovers require local and/or institutional flexibility. Handovers vary throughout Europe and need to take into account factors such as medical and nursing staff involved, availability of recourses and tools used in communication, as well as cultural differences. However, the idea of developing a single approach for all handovers is not feasible due to the diversity and complexity of health-care. HANDOVER will therefore aim at providing standardized basic elements for efficient communication that can be tailored to meet individual, institutional and/or regional requirements.