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Standardised proformas improve patient handover: Audit of trauma handover practice.

ABSTRACT: BACKGROUND:The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists. We present a closed-loop audit of handover practice to assess whether standardised proformas improve clinical data transfer between shifts during handover in our Orthopaedic Unit. METHODS:We collected data handed over between shifts for a period of one week at our department. The data were in the form of hand written data on plain paper used to assist verbal handover. Data were analysed and a standardised handover sheet was trialled. After feedback from juniors the sheet was revised and implemented. A re-audit, of handover data, was then undertaken using the revised standardised proforma during a period of 1 week. RESULTS:Forty-eight patients were handed over in week 1 while 55 patients were handed over during re-audit. The standardised proformas encouraged use of pre-printed patient labels which contained legible patient identifiers, use of labels increased from 72.9% to 93.4%. Handover of outstanding jobs increased from 31.25% to 100%. Overall data handed over increased from 72.6% to 93.2%. Handover of relevant blood results showed little improvement from 18.8% to 20.7% CONCLUSION:This audit highlights the issue of data transfer between shifts. Standardised proformas encourage filling of relevant fields and increases the data transferred between shifts thereby reducing the potential for clinical error cause by shift patterns.

SUBMITTER: Ferran NA

PROVIDER: S-EPMC2565654 | biostudies-literature | 2008 Sep

REPOSITORIES: biostudies-literature

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Standardised proformas improve patient handover: Audit of trauma handover practice.

Ferran Nicholas A NA Metcalfe Andrew J AJ O'Doherty Declan D

Patient safety in surgery 20080925

<h4>Background</h4>The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists. We present a closed-loop audit of handover practice to assess whether standardised proformas improve clinical data tr ...[more]

PMID: 18817559

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Project description:Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value <0.001, n=32). Semi-structured interviews of doctors identified common themes including "a lack of consistency in approach" "poor standardization" and "high variability". Seeking to address concerns of standardization, a standardized handover pro forma was developed using Royal College of Physician (RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).

Project description:ObjectiveTo assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives.Data sources/study settingExisting literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries.Study design/data collectionWe analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians.Principal findingsFirst, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms.ConclusionsUnless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a "culture of learning" at the practice level that incorporates patient feedback.

Project description: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.

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Standardised proformas improve patient handover: Audit of trauma handover practice.

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Standardised proformas improve patient handover: Audit of trauma handover practice.

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