A simple prioritisation system to improve the electronic handover

Abstract

The General Medical Council (GMC) states, “A well managed, thorough and organized handover is crucial for ensuring the quality and safety for patient care,” and in their guidance on safe handover the British Medical Association (BMA) advised that “clinically unstable patients are known to the senior and covering clinicians; tasks should be prioritised; plans for further care are put in place; unstable patients are reviewed.”The orthopaedic department at King's College Hospital, a busy major trauma centre in London, UK, has a significantly reduced workforce during the weekend. The general consensus was that the ward round was taking too long, giving the foundation year one (FY1) doctor very little time to commit to other ward jobs and reviewing unstable patients, making it a stressful and challenging environment.The electronic patient record (EPR), an electronic programme available on all Trust computers, is already a very reliable way to allow safe handover of information via a central electronic database. However it has limitations in clearly prioritising more unstable patients from those needing routine review.We created an easily identifiable traffic light coding system that could be simply incorporated into the electronic handover that was re-reviewed and finalised in order to improve the ability to prioritise patients for senior review. This in turn would directly impact the efficiency of the ward round and improve patient safety.Our immediate results demonstrated the efficiency of the ward round improved in all parameters: time to complete the ward round improved from 7.1% to 50%; prioritisation and ability to highlight the clinical urgency for patient review improved from 15.4% to 100%; and more notably, the clinician's impression of patient safety improved from 38.5% to 100%.Overall the introduction of an uncomplicated traffic light system provided an effective addition to the electronic handover structure aimed to allow patient prioritisation and improved efficiency during weekend hours.

A tool to assess the components of a safe and quality medical handover

“…This met minimum standards set by guidelines, and is an integral part of any handover. [3,7,8,12] There was always prioritisation of patients handed over, since the handover solely includes POC. Beyond this, there was no specific order to the patients discussed; however, unwell patients were sometimes further prioritised, to allow the Registrar to review them immediately after handover.…”

“…[1] This includes diagnosis, clinical condition, up-to-date management plans, and emerging critical information. [1,12] Our handover system includes free text boxes, with no minimum information required. Studies have demonstrated that free-text boxes are often insufficient for safe handover, and to be seen as useful by staff, electronic handovers must be simple, practical and informative.…”

“…Studies have demonstrated that free-text boxes are often insufficient for safe handover, and to be seen as useful by staff, electronic handovers must be simple, practical and informative. [12] Without direction, essential information for a safe handover is frequently omitted, which has implications for patient safety. [15] If a health service relies on electronic handovers, we recommend designing software that requires a certain number of details to be included in order to be submitted, thereby aiding handover safety and effectiveness.…”