Development and implementation of a standardised emergency department intershift handover tool to improve physician communication

Abstract

BackgroundStructured handover can reduce communication breakdowns and potential medical errors. In our emergency department (ED) we identified a safety risk due to variation in quality and content of overnight handovers between physicians.AimOur goal was to develop and implement a standardised ED-specific handover tool using quality improvement (QI) methodology. We aimed to increase the proportion of patients having adequate handover information conveyed at overnight shift change from a baseline of 50%–75% in 4 months.MethodsWe used published best practices, stakeholder input and local data to develop a tool customised for intershift ED handovers. Implementation methods included education, cognitive aids, policy change and plan-do-study-act cycles informed by end-user feedback. We monitored progress using direct observation convenience sampling.MeasuresOur outcome measure was proportion of adequate patient handovers (defined as >50% of handover components communicated per patient) per overnight handover session. Tool utilisation characteristics were used for process measurement, and time metrics for balancing measures. We report changes using statistical process control charts and descriptive statistics.ResultsWe observed 49 overnight handover sessions from 2017 to 2019, evaluating handovers of 850 patients. Our improvement target was met in 10 months (median=76.1%) and proportion of adequate handovers continued to improve to median=83.0% at the postimprovement audit. Written communication of handover information increased from a median of 19.2% to 68.7%. Handover time increased by median=31 s per patient. End-users subjectively reported improved communication quality and value for resident education.ConclusionsWe achieved sustained improvements in the amount of information communicated during physician ED handovers using established QI methodologies. Engaging stakeholders in handover tool customisation for local context was an important success factor. We believe this approach can be easily adopted by any ED.

Mejora en la comunicación durante la transferencia de pacientes entre sectores en un hospital pediátrico

“…En la bibliografía está descripta la disminución de errores luego de la implementación de instrumentos para estandarizar la comunicación escrita y oral durante la transferencia de pacientes. 7,[10][11][12][13][14] Una de las fortalezas de este trabajo fue involucrar a los miembros del equipo de salud que participan del desarrollo de la herramienta. Trabajos recientes indican que el desarrollo de herramientas específicas y locales puede disminuir la resistencia a adoptarlas, ya que elude las barreras culturales y hace que los profesionales las sientan como propias, empoderando a la vez a quienes participan del proceso.…”

“…Trabajos recientes indican que el desarrollo de herramientas específicas y locales puede disminuir la resistencia a adoptarlas, ya que elude las barreras culturales y hace que los profesionales las sientan como propias, empoderando a la vez a quienes participan del proceso. [14][15] En el caso aquí presentado, la implementación del formulario condujo a similares resultados que los publicados.…”

“…Vencer esta resistencia al cambio requiere un cambio en la cultura de la seguridad. [11][12][13][14][15][16] Es necesario seguir trabajando en la cultura de la seguridad del paciente e incorporarla de manera formal en los programas de enseñanza. Para lograr progresos, se debe trabajar en mejorar la comunicación y el trabajo en equipo.…”

Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea

“…In 2009, Grady et al [ 14 ] stated that there should be an adequate balance between the risk associated with resident fatigue and those associated with an inexperienced neurosurgical work force for public health. However, many researchers reported that as the WTL for resident physician has increased the number of resident hand-off and reduced practical experience, thus there were variety of concerns that the number of medical errors and complications might increase, resulting in worse patient outcome [ 8 , 9 , 14 , 16 , 17 , 20 , 22 , 24 , 26 ].…”

Shift Handover Practices Among Nurses in Medical Wards: A Qualitative Interview Study

“…Several studies have a look into the handover processes in emergency settings (16). In order to develop a better understanding of handover processes in medical wards and provide insights that will inform effective strategies to enhance patient care and safety, we undertook a qualitative study using semi-structured interviews.…”