Standardised proformas improve patient handover: Audit of trauma handover practice

Ferran, Nicholas Antonio; Metcalfe, Andrew; O'Doherty, D.P.

doi:10.1186/1754-9493-2-24

Cited by 68 publications

(59 citation statements)

References 4 publications

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“…Ferran et al studied the use of standardised proformas to improve patient handover, auditing information handover for trauma patients before and after the introduction of a proforma. 11 Standardised proformas led to significantly less information loss, however, some information was still poorly handed over even with the proformas. Grainge et al have shown a standardised weekend handover form can improve documentation, for example of resuscitation decisions.…”

Section: Discussionmentioning

confidence: 99%

Are weekend handovers of adequate quality for the on-call general medical team?

Pfeffer¹,

Nazareth²,

Main³

et al. 2011

Clinical Medicine

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-Weekend handover is vital for patient safetypoor handover is a cause of avoidable adverse events. This study evaluated whether the quality of information handed over for patients requiring weekend review was adequate. Two external doctors imagined themselves as the doctor on-call and judged whether the handed-over information was adequate for each case. Of the 1,130 handovers evaluated, 867 were handed over using a computerised proforma and discussed at the handover meeting, 148 using the computerised proforma but not discussed, 30 handovers were handwritten. Of handovers of patient details and background information, 87.3% were judged of adequate quality by the first auditor and 86.0% by the second. Similarly 70.6% and 75.8% of handovers of action plans were of adequate quality. Use of computerised proforma and discussion at a handover meeting gave the highest percentage of handovers of adequate quality, however, there was room for improvement. Training in handover may improve communication. KEY WORDS: communication, handover, patient safety, sign-out IntroductionHandover of patients is of critical importance in good clinical care. With new working time directives, junior doctor shift work has increased. 1 Often doctors on-call at the weekend will be unfamiliar with patients needing review, 2 relying on information on handover sheets. Handovers need to be clear and time efficientcommunication failure as a cause of preventable adverse events and deaths has been a major concern of health systems for many years. [3][4][5] One study found 24 adverse events arising from 503 patient night handovers. 6 Common causes of such events were inadequate description of current patient condition, deficient anticipatory guidance and lack of explanation of rationale for management plans. Omitted content from handover was the most common cause of deleterious communication failure in another study. 7 Illegible handwriting can also be a problem.Queen's Hospital, Romford, is a large district general hospital with 340 general medical inpatient beds, 22 general and acute medical consultants and an average of 330 medical admissions each week. At the weekend there are nine junior doctors covering the acute medical take and the medical wards. It is only feasible to review a selected proportion of medical inpatients over the weekend. Given the importance of safe handover, a service evaluation of the quality of information handover for medical inpatients needing weekend review was conducted. Method Phase 1 -Entering of informationPatients needing weekend review were identified by their routine weekday team and their information entered onto an electronic database tool before 4pm on a Friday. Data fields included patient details, clinical background and action plan (Table 1).Paul E Pfeffer, specialist registrar in respiratory and general medicine, Queen's Hospital Romford, Barking Havering and Redbridge University Hospitals NHS Trust; Dilip Nazareth, specialist registrar in respiratory and general internal medicine, Liverpool Hear...

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Section: Discussionmentioning

confidence: 99%

Are weekend handovers of adequate quality for the on-call general medical team?

Pfeffer¹,

Nazareth²,

Main³

et al. 2011

Clinical Medicine

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“…The topics covered on our checklist include those used in previously developed checklists, including diagnosis, comorbidities, history, mechanism of injury and outstanding injuries. 5,[7][8][9]12 It is important to remember that our checklist is not exclusive; it contains a column for "other pertinent information" to address the variability among patients who present with traumatic injuries. The checklist provides a starting point for information that should not be missed, but as seen in Table 2, most of the information has been deemed important by a panel of orthopedic surgeons and trainees across the country and any can be added at the discretion of the admitting physician.…”

Section: Discussionmentioning

confidence: 99%

“…5,9 The British Medical Association (BMA) has advocated that every hospital should have their own handover policy and specify who should be involved, when handover should take place, where it should occur and what needs to be handed over. 1 Therefore, the purpose of the present study was to identify and survey Canadian Orthopaedic Association (COA) members about the vital clinical information needed for the development of a standardized, preoperative handover checklist for use with trauma patients.…”

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confidence: 99%

“…1 The risks to patient care associated with handover have been extensively studied among health care workers, including personnel from prehospital care, emergency department, nursing, intensive care unit (ICU), anesthesiology, general surgery, plastic surgery, neurosurgery and orthopedic surgery. [2][3][4][5][6][7][8][9][10][11][12] Many groups have proposed handover checklists as a manner to improve information retention and handover safety. [13][14][15][16][17] Medical errors are common, occurring in 3.2%-10.6% of patients, 18,19 and it is estimated that 58%-66% of these errors will result in patient injury.…”

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confidence: 99%

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Development of an orthopedic surgery trauma patient handover checklist

et al. 2014

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Development of an orthopedic surgery trauma patient handover checklistBackground: In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. Methods:We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Results:Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Conclusion:Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.Contexte : En chirurgie, le transfert préopératoire des polytraumatisés nécessi-tant une chirurgie est un processus que l'on doit rendre aussi sécuritaire que possible. Nous avons voulu déterminer quels renseignements cliniques vitaux doivent être transmis aux équipes de soins et préparer une liste de vérification standardisée à cette fin.Méthodes : Nous avons réalisé des entrevues standardisées par petits groupes au sujet du transfert des polytraumatisés. À partir des renseignements recueillis, nous avons élaboré un questionnaire pour obtenir le point de vue de tous les membres de l'Association canadienne d'orthopédie (ACO) au sujet des élé-ments jugés les plus importants sur une liste de vérification en vue du transfert. Nous avons analysé les réponses pour dresser une liste de vérification standardisée.Résultats : Sur les 1106 membres de l'ACO, 247 ont répondu au questionnaire. Les 7 éléments jugés les plus importants pour assurer la sécurité des patients lors du transfert ont été : comorbidités, diagnostic, état de préparation pour le bloc opéra-toire, stabilité, blessures connexes, histoire et mécanisme du traumatisme et questions en suspens. Les recommandations des experts ont été les suivantes : que les transferts s'effectuent de la même façon chaque jour, qu'on obtienne toutes les radiographies appropriées disponibles, qu'on dispose de temps suffisant, qu'on obtienne toute les analyses de lab...

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“…Depending on what information needed to be transmitted communication should be either verbal [51] or in writing [34] as free text or structured forms [41]. Four of the structured forms described in detail were derived from the SBAR method or modified it [45,55,56,58], but also other generic mnemonics [42,47,54], specific checklists [48,57] or minimum data sets [49,52] were used.…”

Section: Mode and Structure Of Communicationmentioning

confidence: 99%