Introduction of a new electronic medical weekend handover at Tunbridge Wells Hospital

Vithlani, Rohan

doi:10.1136/bmjquality.u204755.w2342

Cited by 7 publications

(5 citation statements)

References 2 publications

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“…Electronic handovers have been suggested as a potential solution to improve patient safety [11][12][13], with the importance in the accessibility of live patient details and management plans being emphasised by the BMA and RCS [5]. Similar studies have explored the impact of electronic handover systems, however, they used subjective measures to review their effectiveness, such as surveys to explore doctors' views [14][15][16]. Our QIP by comparison, provides a quantitative analysis, assessing how well e-handovers were updated pre-and post-educational interventions.…”

Section: Discussionmentioning

confidence: 99%

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project

Tan¹,

Park²,

Patel³

et al. 2021

Cureus

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Background National guidance stipulates the essential components of a safe handover. Shift-based work and the COVID-19 pandemic has led to an increased turnover and re-deployment of staff into new clinical areas, creating challenges in delivering effective handovers. Aim The aim of this quality improvement project (QIP) was to improve adherence to a local standardised handover proforma to improve the quality and consistency of handovers. Methods Handovers were assessed by measuring the completion rates of the essential components of a safe handover as outlined in the national guidance. Data were collected from an electronic handover system which follows the Situation, Background, Assessment and Recommendations (SBAR) structure, and percentage completion rates obtained for each component assessed. Following baseline measurement, four Plan-Do-Study-Act (PDSA) cycles were completed between August 2020 and February 2021 across two junior doctor rotations and during a COVID surge rota. Results A total of 710 handovers were assessed across the four PDSA cycles. There were overall improvements in the percentage completion rates of each component compared to baseline: Under ‘Situation’, admission dates increased by 13.7%, estimated discharge date by 33.3% and 100% completion rate maintained for the presenting complaint. Under ‘Background’, past medical history remained static, with a 12.1% increase in documentation of a social history. Under ‘Assessment’, escalation status increased by 335%, issues list by 242% and important updates by 35.2%. Under ‘Recommendations’, completion rate for plans was maintained at 100%. Conclusions Our findings demonstrated an overall improvement in the majority of components of the handover proforma. Challenges remain with the rotation of junior doctors through different specialties leading to a loss of institutional knowledge and reduced longevity of the intervention’s effect, exacerbated by the introduction of the COVID surge rota. A long-lasting improvement may require a shift to a completely electronic patient records system (ePR) which incorporates a handover tool.

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Section: Discussionmentioning

confidence: 99%

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project

Tan¹,

Park²,

Patel³

et al. 2021

Cureus

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“…There are benefits to an electronic medical handover, such as legibility, providing more in-depth information than written handovers, and improved staff satisfaction. [16,17] Despite these benefits, our data demonstrates difficulties in accessing up-to-date management plans and patients' current clinical status. As discussed, mechanisms must be implemented in a healthcare service to ensure minimum content information is reached, in both verbal and electronic handovers.…”

Section: Implications For Policy Practice and Researchmentioning

confidence: 97%

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

Forbes,

Jayamaha,

Lee

2024

Hosp Admin Med Pract

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Background: Robust medical handovers are paramount to ensure patient safety throughout the course of a hospital admission. Anecdotal evidence within our Australian tertiary hospital suggested that medical handovers were typically less structured when compared to allied health handovers. Medical handovers at our hospital had never been evaluated before, and the development of a questionnaire to assess the key components of a safe and quality handover was necessary. This tool would evaluate our medical handovers, and identify potential areas for improvement in both the tool, and medical handover practice. Methods: Based upon a literature search, and local and national guidelines of best practice, the tool was created around six key components of quality medical handovers—members involved in handover, environment and logistics, structure and content, management plans, patient-related and documentation. The tool was developed to audit the after-hours team handover at our 600-bed tertiary hospital. The tool was trialled at 20 medical handovers for our after-hours team, results were captured on REDCap, and data analyzed. Results: The tool was useful in assessing a wide range of key medical handover components and highlighting areas for improvement within our medical handovers. Through this trial, limitations were discovered in the tool that can be incorporated into future revisions of the tool. Conclusion: Overall, this study provided valuable insight into medical handovers by identifying current clinical practice and highlighting areas for improvement. The broader utility of this tool is the ability of other health services to evaluate their own medical handover, or serve as a starting point to develop their own audit tool.

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“…Although our handover tool is relatively simple and intuitive to use, we did not consider potential information technology problems 15 that could have arisen. For similar projects, or any amendments to the handover tool, a simulation session or formal induction may be beneficial.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

“…Lastly, many projects had relatively small sample sizes, in terms of the number of people surveyed, 15 17 21 or the number of handovers analysed. 10 18 The larger sample sizes of our project helped accommodate for any discrepancies between weekends and ensured that the data collected were true representation of the quality of handover documentation.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Making the weekend work: a local quality improvement project to establish and improve the quality of weekend handover

Heller

2018

BMJ Open Qual

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Handover is widely identified by the National Confidential Enquiry into Patient Outcome and Death, the Royal College of Physicians (RCP) and Health Foundation as an area that can lead to shortcomings in patient care. We recognised that the current weekend handover process in the Trauma and Orthopaedics department at Frimley Park Hospital was dated, time-consuming and did not promote handover of sufficient patient details.The Royal College of Surgeons, British Medical Association and RCP have guidelines on handover. Our aim was to use these to establish the quality of handovers and introduce methods to better the accuracy and effectiveness of weekend handover in the department, thus improving patient care and safety.Initially, we measured the quality of the existing handover documentation for how comprehensively it was completed. We then implemented a two-step change, reauditing each step, resulting in a handover tool on the trust intranet. Finally, we repeated our audit to monitor sustainability.The 10 categories measured were: ‘Patient name’, ‘Date of birth’, ‘Hospital number’, ‘Date of admission’, ‘Location’, ‘Consultant’, ‘Admission reason’, ‘Date of operation’, ‘Frequency of review’ and discharge paperwork (‘TTO’).The original handover documentation had good compliance with ‘Patient name’ (99%), ‘Hospital number’ (94%) and ‘Admission reason’ (91%) but was poor in all other categories, ranging from 12% to 84%. The only category that met its standard was ‘Admission reason’.Almost every category improved with the new intranet tool. Five areas met their standard (‘Patient name’, ‘Location’, ‘Consultant’, ‘Admission reason’ and ‘Frequency of review’). Specific prompts resulted in 100% compliance for ‘Frequency of review’. The poorest compliance was again seen for ‘TTO’ (18%).In a short four months, we created an intranet handover tool that resulted in significant and sustainable improvements in the quality, detail and accuracy of handovers, making identification of sick patients safer and more efficient.

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Introduction of a new electronic medical weekend handover at Tunbridge Wells Hospital

Cited by 7 publications

References 2 publications

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project

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

Making the weekend work: a local quality improvement project to establish and improve the quality of weekend handover

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