Article Text
Abstract
Background Effective handover is key in preventing harm.1 In the Acute Surgical Receiving Unit of Ninewells Hospital, Dundee, large numbers of patients are transferred daily. However, lack of medical handover during transfer means important tasks are missed. Our aim was to understand and reflect on the current system and test changes to improve medical handover.
Aim Our aim was to ensure that 95% of patients being transferred from the Acute Surgical Receiving Unit receive a basic medical handover within 2 months.
Methods Initially, we collated issues that were missed when patients were transferred. These data coupled with questionnaire data from members of the team fed into the creation of a handover tool. We proposed to link our tool with the nursing handover, hence creating one unified handover tool. We completed six full Plan-Do-Study-Act (PDSA) cycles (two on communication to aide handover and four on the tool itself) to assess and develop our tool.
Results By our final PDSA cycle, 84% (33/39) of the patients had a handover, meaning no tasks were missed during transfer. After 4 months, 9 out of 10 staff felt that the introduction of the handover sheet made the handover process smoother and 8 out of 10 felt that the handover sheet improved patient safety and quality of care.
Conclusions Improving handover can be challenging. However, we have shown that a relatively simple intervention can help promote better practice. Challenges are still present as uptake was only 84%, so work still has to be done to improve this. A wider cultural change involving communication and education would be required to implement this tool more widely.
- quality improvement
- hand-off
- patient safety
- teamwork
- communication
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Footnotes
NR and GM contributed equally.
Contributors This project was planned and designed both equally by NR and GM. NR designed and produced the initial handover prototype in collaboration with the MDT. GM collected both the pre/postintervention questionnaire data as well as developing communication tools. Both GM and NR collected the live data of the handover process throughout the four PDSA cycles. VT provided support and guidance on how to complete and approach a quality improvement project as the hospital lead for patient safety and quality improvement; she also supported with the editing revisions of this submission. KC (Physician Associate in ASRU) was key in helping to implement this tool and collect data through the four PDSA cycles. NR drafted the majority of this revision with support from GM with the baseline measurement and results sections as well as the figures/tables.
Funding This project received no direct funding from any internal or external bodies. The publishing costs were funded by NHS Tayside’s subscription to BMJ Open Quality as the manuscript was initially submitted in June 2017.
Competing interests None declared.
Ethics approval This was a quality improvement project and in line with NHS Tayside policy is exempt from ethical approval.
Provenance and peer review Not commissioned; externally peer reviewed.