The end of weak handover
Aims
The Royal College of Physicians (RCP) and National Institute for Health and Care Excellence (NICE) have identified out-of-hours handover as a vulnerable time for patient care, often due to human error or system failures. We aimed to improve the efficiency and safety of weekend handover by integrating the process into our existing electronic patient record (EPR).
Methods
Local procedures for weekend handover previously consisted of a verbal handover and a weekend list, based on a pro forma from the hospital intranet. Following incidents and concerns expressed by trainees, we redesigned the handover process.
Pre-intervention evaluation was based on the RCP acute care toolkit 1: Handover and we investigated weekend activity levels. In conjunction with the information technology team, we created a weekend handover list option on EPR where doctors can simultaneously add required reviews to a single electronic document. This is then generated by the weekend ward cover doctor on arrival.
During the crossover period before the new system was fully introduced, we used both methods of handover to ensure patient safety. We evaluated post-intervention data using the same criteria. Data from all medical weekend reviews were gathered over one weekend, before and after implementation.
Results
Forty-five patients were included in the pre-implementation evaluation and 85 in the post-implementation evaluation. Documentation of background history (11 to 51%) and details of the doctor giving handover (0 to 100%) improved. There was a marked improvement in measures of weekend activity. Ninety-nine percent of patients handed over received reviews compared to 80% previously. On average, unwell patients were reviewed 2 hours earlier (13.34 vs 11.34).
Parameters including patient name, date, date of birth, NHS number, location and responsible consultant were documented in 100% of cases but these had been well-documented previously. The only measure that worsened was ‘aims and limitations of treatment’ (91 to 43%). Urgency of reviews was never documented, which is recommended by the RCP.
Conclusion
Integrating out-of-hours handover into the existing electronic patient record has significantly improved the accuracy of weekend handover. The EPR handover has had a positive impact on patient safety with increases in the proportion of patients reviewed and timeliness of reviews. To improve this process we are developing a prioritisation indicator and a method to highlight treatment escalation plans. Additionally, we plan to launch the process to include Hospital at Night handover to ensure consistency of care over 24 hours.
Conflict of interest statement
None declared.
Footnotes
↵*Royal College of Physicians chief registrar
- © Royal College of Physicians 2019. All rights reserved.
Article Tools
Citation Manager Formats
Jump to section
Related Articles
- No related articles found.
Cited By...
- No citing articles found.