BackgroundHandover of care is one of the most perilous procedures in medicine.1The unique shift-based work in the ED, where there is a high degree of patient turnover, unpredictability and patient volume can create challenges to good quality clinician and nursing handover.The above highlights a need for an improved and standardised patient bedside handover tool for both clinicians and nurses involving and empowering patients and families. Both handover tools will cement safe continuity of information between shift changes and improved communication with patients and families.Method and resultsA standard operating procedure, flowchart and clinician’s handover tool was designed to maximise safe handover as illustrated in figure 1. The tool has been introduced into the department since June 2017. After the introduction of the tool, an evaluation survey of 30 participants across various grades of clinicians was performed.Abstract 001 Figure 1Clinicians handover toolBuilding on the success of the clinician’s handover tool; a standard operating procedure, flowchart and the first standardised nurse’s handover tool was designed as illustrated in figure 2.Abstract 001 Figure 2Nurses handover toolConclusionsFor the month of September 2017, 30 completed surveys evaluating the clinician’s handover tool was collected. 100% positive responses were received stating they found it useful. The handing over clinicians commented feeling more satisfied that ‘their patient was appropriately and safely handed over at the bed side in front of the family’.The nurse’s handover over tool was praised as nurses felt ‘happier’ with handover and more satisfied to leave shift ‘without forgetting significant patient information’.Both tools have become routine practice within the ED and are very useful adjuncts to improve patient safety within the department.Multidisciplinary handover post-shift work at the bedside has become standardised practice and improved patient safety with continuity of care with these tools. Regular ongoing audit have demonstrated that the tools are routinely used by both clinicians and nurses.ReferenceBritish Medical Association. Safe handover: safe patients. Guidance on clinical handover for clinicans and managers. London: BMA, 2004.
AimsHandover is an important tool in clinical medical practice. Handovers are the transfer of responsibility for care from a group of doctors to another, alerting the team about sick patients, staffing issues and anticipate any problems that may arise. This closed loop audit was performed to assess the length and quality of handovers using the SBAR tool.MethodsThis prospective audit collected data using a proforma between May to June 2016. Morning, afternoon, night handovers during the week and weekends were included. The re-audit was performed between October and November 2016. The proforma collected data on start times, finishing times, reasons for delay, members of staff present including consultants and a comment section for notes on that specific handover. At the end of each handover, two doctors receiving the handover were asked to score the quality of SBAR handover in view of structure and clarity and effectiveness for the shift ahead (1- Strongly Agree, 2 Agree, 3- Disagree, 4 Strongly disagree).ResultsIn May to June 2016, (n=41 handovers) 15 morning handovers, 10 evening handovers and 16 night handovers were assessed. The average time for morning handovers were 26.8 min however the neonatal consultant attendance was 34% (5/15). On re-audit in October and November 2016, (n=25 handovers) 12 morning handovers, 5 afternoon handovers, 5 night handovers and 3 weekend handovers. The average time for morning handovers increased to 30.3 min, however neonatal consultant attendance in morning handovers increased to 75% (9/12). While the handovers on average were still 30 min in length, 20% of handovers either start late or finish late. Overall, more than 85% of handovers the receiving team answered strongly agreed or agreed that SBAR handover was structured with clarity and effectiveness for the upcoming shift.ConclusionThis audit for evaluating length and quality in paediatric handovers identified areas requiring most improvement. Areas for ongoing improvement included introduction of a safety briefing and inclusion of nursing presence within handovers. Further improvement strategies include a handover checklist to include safety brief, staffing levels, highlighting sick patients and encouragement of the SBAR format for trainee assessments.
Introduction Ensuring correct documentation and safe handover is key to the running of a successful surgical department. At Imperial College Healthcare Trust, this process has been made easier through various electronic systems available to our Orthopaedic department: our in-house CERNER system and out-of-house system eTrauma, the latter of which is predominantly used. The aim of this project was to assess our efficiency in terms of time management between the two systems, as well as financial implications of saved time. Method Multiple members of the Orthopaedic team timed themselves when entering information regarding a referral or an admission into both systems. This allowed us to estimate the financial implications of moving away from eTrauma. Results An average referral took 165 seconds (n = 27) to input information onto eTrauma, versus 38 seconds (n = 25) for CERNER. Time taken to document an admission was 127 seconds (n = 33) and 26 seconds (n = 31) respectively. The current hourly wage for our junior members is £22.84 per hour or 38p per minute. Moving away from eTrauma to CERNER will save around £1.50 for every 2 referrals and 2.5 admissions, solely from documentation. This is excluding the other benefits of CERNER, such as quick access to relevant clinical information, pathology results and imaging. Conclusions Leaving eTrauma behind will reduce the time spent on documentation by orthopaedic junior doctors. This will result in increased efficiency and will lessen the financial burden on an already overstretched budget. Our formal data will contribute to decision making and future resource allocation in our local Trauma and Orthopaedic Department.
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