Identifying barriers and developing strategy to improve uptake of a new ED to ward handover tool using behaviour change theory

Ms Kate Ruperto1, Ms Tiana-lee Elphick3, Ms Madeline Eyles3, Professor Kate Curtis1,2

1Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia, 2Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia, 3Research Central, Illawarra Shoalhaven Local Health District, Wollongong, Australia


Clinical handover is fundamental to clinical practice and is recognised as a national priority. The clinical handover from the Emergency Department (ED) to inpatient ward across four hospitals in a Local Health District (LHD) was identified in a number of reportable clinical incidents.  To address this, an ED to inpatient ward electronic clinical handover tool was developed and implemented within the LHD to support ED to ward handover.


The aim of the research was to determine the facilitators and barriers of the ED-to-Ward Handover Tool implementation, to improve compliance.


An exploratory multi-method approach was used to identify barriers and facilitators to the implementation of an ED to Ward Handover tool. An audit of electronic medical records assessed use of the newly implemented ED to ward handover tool. A 13-item electronic survey using six domains based on the Theoretical Domains Framework (a behaviour change model known to improve sustainable uptake in the clinical environment) was distributed to the 3,000 nurses across the LHD. Both quantitative (five-point scale Likert scale questions), and qualitative (free text responses) data were collected to identify barriers and facilitators. Barriers were then mapped to the corresponding intervention strategies to inform a “re-implementation” plan.


Uptake of the tool was mixed between both sites and wards, with compliance varying from 45-90% depending on site. The 300 respondents reported five barriers and five facilitators, with the majority of barriers in the beliefs domain. Barriers varied according to sites, and between emergency and ward contexts. The integration of data informed the strategy to improve compliance.


Behaviour change informed research has determined the facilitators and barriers to use of a newly implemented clinical handover tool, to inform an implementation strategy to improve compliance.


This study was funded by the NSW Ministry of Health, System Purchasing branch


Kate Ruperto RN, MN (Critical Care), Grad. Dip Adult Education.

I have always had a passion for Emergency Nursing starting my career in 2000.  I worked in the UK in 2002-2003 in various London Emergency Departments as well as community settings, while also spending some time in other critical care areas within Australia while completing my masters.  It was always emergency nursing which interested me most and I have continued to work in this area as an RN, CNS, CNC and Nurse Educator.

I am very interested in the development of emergency nursing as a profession and supporting the individual practitioner in developing an Emergency Department career.  My current role allows me to be involved with the career development and education of other emergency nurses as well as support and develop practice.