Development and implementation of electronic medical handovers across psychiatric hospitals: quality improvement initiative

Abstract

A lack of integration between internal processes and failure to use the full potential of information technology (IT) systems is common in psychiatric hospitals. We aimed to reduce the number of out-of-hours medical errors by ensuring that there is consistent and transparent weekend medical handover by creating an electronic handover system that is easy to use, robust and embedded into the existing trust IT systems. We employed quality improvement (QI) methodology to address this issue.After trialling in a single site followed by six cycles of improvement, the weekend medical handover system is now in use across four boroughs and has been integrated into trust policy. It has received qualitative and quantitative evidence of improvement, with 100% of doctors reporting the system improved patient care and a 64% (from 11 to 4 events/year) reduction in moderate, severe and catastrophic adverse incidents occurring out-of-hours within the older adult service (p=0.29, χ2 1.117).The increasing number of complex patients with comorbid medical illness in psychiatric inpatient services demands robust handover systems similar to that of an acute trust. This QI work offers a template for achieving this across other psychiatric trusts and demonstrates the positive change that can be achieved.

Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review

“…The features of the EMRs were described in 8 of the 12 (66.7%) primary studies in mental health settings. Features ranged from the simple electronic storage of personal and health information documentation [ 28 ], e-ordering of consultations [ 31 ], and capability to enter free-text notes [ 30 ] to features that aimed to improve care quality including embedded assessment tools [ 32 , 35 , 36 ], and care coordination plans [ 29 , 32 , 38 ]. Specific examples included implementing automated alerts to develop safety plans for children and youth with suicidal ideations [ 35 ] and embedding an e-consultation pathway prompt linking primary health providers with a psychiatrist [ 31 ].…”

“…Adoption was reported in 10 of the 23 included studies (43.5%), namely 4 of the 12 primary studies (33.3%) [ 29 , 32 , 33 , 38 ] and 6 of the 11 reviews (54.5%) [ 27 , 41 , 42 , 45 , 48 , 49 ], as shown in Figure 2 . Factors influencing the adoption of EMRs fell into three categories: organizational, technical, and financial.…”

“…In contrast, poor leadership and buy-in, high staff turnover, and poor capacity or unwillingness to change, resulted in lower adoption rates [ 32 ]. Two primary studies suggested that adoption was high without reflecting on the reasons for this [ 29 , 38 ]. Similarly, the reviews reported that organizational structure, readiness for change, participation of leaders and end users in planning and implementation, and support for end users impacted adoption [ 41 , 42 , 49 ].…”

“…Among the included studies, 2 out of the 12 primary studies (16.7%) [ 35 , 38 ] and 8 out of the 11 reviews (72.7%) [ 27 , 41 , 42 , 44 - 46 , 48 , 49 ] reported on clinician acceptance of (or satisfaction with) the implemented EMRs or aspects of EMRs ( Figure 2 ). Reviews reported that positive clinician attitudes were necessary for successful adoption of EMRs [ 42 , 45 , 48 ].…”

“…One primary study found that mental health clinicians were neutral about the addition of an alert for a mental health safety plan in EMRs [ 35 ], whereas another found there were fewer complaints regarding the quality of clinical handover following the introduction of out-of-hours electronic handover systems in the EMRs [ 38 ].…”