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Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety.

ABSTRACT: The European Working Time Directive and economic challenges have led to a paradigm of shift-work becoming common, and yet the continuation of high-quality patient care remains paramount. Effective and safe transfer of clinical information is critical as emphasised by the Royal College of Surgeons document 'Safe handover: Guidance from the Working Time Directive working party (March 2007)'. The aim of this project was to design and implement a handover proforma in order to deliver a more efficient and safer system for patient care over the weekend. The surgical weekend handover proforma was designed following consultation with nursing and medical colleagues. It included a traffic light scoring system to alert the on-call team of the urgency of clinical review. An educational session was delivered to junior doctors on the surgical rotation to ensure accurate completion of the proforma. All trainee surgical doctors from Foundation Year 1 to Specialist Registrars were asked to complete a pre- and post-intervention questionnaire. Improvement was noted in all categories measured. 85% of the firms were using the new surgical weekend handover sheet. 78% of junior doctors were confident in understanding the patient's condition and executing the clinical jobs faster, with ward rounds lasting less than 3 hours. On average, 20% of patients were discharged per weekend during the trial period. Robust patient handover is vital to maintain patient safety and avoid adverse events. Our findings support the use of a surgical proforma to provide a consistent and structured approach to inpatient handover during the weekend.

SUBMITTER: Din N

PROVIDER: S-EPMC4652679 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety.

Din Nizar N Ghaderi Shahrzad S O'Connell Rachel R Johnson Tayo T

BMJ quality improvement reports 20121206 1

The European Working Time Directive and economic challenges have led to a paradigm of shift-work becoming common, and yet the continuation of high-quality patient care remains paramount. Effective and safe transfer of clinical information is critical as emphasised by the Royal College of Surgeons document 'Safe handover: Guidance from the Working Time Directive working party (March 2007)'. The aim of this project was to design and implement a handover proforma in order to deliver a more efficien ...[more]

PMID: 26734154

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Project description:IntroductionPatient handover is a crucial transition requiring a high level of coordination and communication. In the BC Children's Hospital (BCCH) pediatric intensive care unit (PICU), 10 adverse events stemming from issues that should have been addressed at the operating room (OR) to PICU handover were reported into the patient safety learning system (PSLS) within 1 year. We aimed to undertake a quality improvement project to increase adherence to a standardized OR to PICU handover process to 100% within a 6-month time frame. In doing so, the secondary aim was to reduce adverse events by 50% within the same 6-month period.MethodsThe model for improvement and a Plan, Do, Study, Act method of quality improvement was used in this project. The adverse events were reviewed to identify root causes. The findings were reviewed by a multidisciplinary inter-departmental group comprised of members from surgery, anesthesia, and intensive care. Issues were batched into themes to address the most problematic parts of handover that were contributing to risk.InterventionA bedside education campaign was initiated to familiarize the team with an existing handover standard. The project team then formulated a new simplified visual handover tool with the mnemonic "PATHQS" where each letter denoted a step addressing a theme that had been noted in the pre-intervention work as contributing to adverse events.ResultsAdherence to standardized handover at 6 months improved from 69% to 92%. This improvement was sustained at 12 months and 3 years after the introduction of PATHQS. In addition, there were zero PSLS events relating to handover at 6 and 12 months, with only one filed by 36 months. Notably, staff self-reporting of safety concerns during handover reduced from 69% to 13% at 6 months and 0% at 3 years. The PATHQS tool created in this work also spread to six other units within the hospital as well as to one adult teaching hospital.ConclusionA simplified handover tool built collaboratively between departments can improve the quality and adherence of OR to PICU handover and improve patient safety. Simplification makes it adaptable and applicable in many different healthcare settings.

Project description:BackgroundEffective handover is crucial for patient safety. Rural health care organisations have particular challenges in relation to handover of information, placing them at higher risk of adverse events. Few studies have examined the relationship between handover and patient safety in rural contexts, particularly in Australia. This study aimed to explore the effect of handover on overall perceptions of patient safety and the effect of other patient safety dimensions on handover in a rural Australian setting.MethodsA cross-sectional online survey using The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was implemented across six rural Local Health Districts in NSW, Australia and resulted in 1587 respondents. Hierarchical multiple linear regression analysis was conducted to account for the nested nature of the data. Models were developed to assess the effect of handover on patient safety perceptions, and the effect of other patient safety culture composites on handover variables. Open-ended questions about patient safety were inductively analyzed for themes. Quotes from the handover theme are presented.ResultsAll models were significant overall (p < .001), with explanatory powers ranging from 29 to 48%. Within rural health settings, effective handover is significantly related to patient safety perceptions (R2 = .29). A strong teamwork culture and management support culture was found to enhance effective handover of patient information (R2 = .47), and effective handover of personal responsibility (R2 = .37). A strong teamwork, management support, and open communication culture enhances handover of department accountability (R2 = .41). Despite the implementation of standardised communication tools and frameworks for handover, patient safety is compromised by inadequate coordination, poor or absent documentation between departments, between other health care agencies and in transfer of care from acute facilities to primary/community care.ConclusionApproaches to handover need to consider the particular challenges associated with rurality and strengthening elements found to be associated with increased safety, such as a strong teamwork and management culture and good reporting practices. Research is required to examine how communication at transition of care, particularly between facilities, is conducted and ways in which to enhance patients' and families' participation.

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Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety.

Publications

Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety.

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