Problem
The handover of patient information between doctors is often highlighted as an area of importance and a potential time for errors to occur.[1][2] Patient safety is vital in any hospital setting; encouraging concise yet comprehensive handover of care should aim to avoid such issues. This is particularly important with regards to weekend handover, which requires junior doctors to document clear plans for implementation over the following days and anticipate which patients will require regular medical review. The job of completing handover sheets often falls to the most junior members of the medical team, who lack training on the completion of these sheets.
The medical team handover in North Bristol NHS Trust (NBT), a tertiary referral centre in England, currently takes the form of a printed proforma for identifying patients that have outstanding investigations or require weekend reviews. The handwritten sheets are completed on Friday by doctors on each ward and filed in the office for the on-call team. This system for the handover for specific patients is in accordance to existing recommendations for use of written and standardised documentation for weekend handovers.[3][4]
However, this proforma is extremely brief, often failing to explain in adequate detail each patient's background and ongoing significant issues. There is some variety in the format of the handover sheets; they are often not uniform and may differ in the extent of completion. Furthermore, weekend ward cover usually involves reviewing a number of patients on the wards who become increasingly unwell and were not included in the weekend handover for review.[5]
This means that patient notes, particularly the most recent entries, are the primary source of patient information for the on-call team. Daily documentation by medical teams familiar with these patients can be inconsistent regarding the detail included, resulting in on-call doctors spending time filtering through patient notes to identify current problems and the management plan. Documented decisions such as the ceiling-of-care are frequently difficult to find, if present at all. This may cause unnecessary investigations or treatment, and further time spent in discussion with the intensive therapy unit (ITU).
Prior to the weekend, clearer documentation of patient's current issues, weekend plan, and ceiling of care would save time, improve continuity of care for patients, and reduce stress for junior doctors when dealing with unfamiliar patients.