The medical on-call handover – more than just a meeting
In one of the largest and busiest teaching district hospitals in the UK situated in the West Midlands, the 94-bedded acute medical unit has a rapid turnover of patients. The journey of a medical admission starting from the emergency department or primary care until discharge can vary in length, with patients rapidly distributed to general medical wards across the hospital. The management of these inpatients along with new continuous medical admissions falls under one small but pivotal team at night, running a large portion of the hospital for 12.5 hours. This highlights the importance of an efficaciously functioning team with a positive morale to partake, thrive and develop from these demanding on-call commitments. We recognised that the medical night handover in our trust consisted of a range of professionals, but lacked essence of teamwork and ran in a disjointed manner.
We designed a quality improvement project (QIP) identifying the problem and analysing it further using a fishbone diagram (Fig 1) to determine cause and effect of unfavourable factors in the meeting. A questionnaire assessed how the current medical handover meeting was perceived by attendees, including doctors of all grades, advanced nurse practitioners and resus team members. Questions related to the night handover included whether there were clear introductions of roles and responsibilities, a recognisable identified person leading the handover, presence of any interruptions, identification of any operational issues including bed state, and an overall impression of whether the handover was run in an organised manner. A score out of 5 was calculated using the above points plotted on a run chart. Baseline data included a median response of 2/5 from 30 respondents. Our intervention included a handover template incorporating pertinent handover subheadings, reducing chances of missing any important patient handover details, which was implemented to be followed for the duration of the meeting by the lead registrar. A subsequent survey of 30 respondents demonstrated an increase in our median score to 3.5/5 (Fig 2). Identification of operational issues, including bed state situation, remained unchanged; however, improvement in structure of the handover, better teamwork, training environment and support for members of the on-call team at night increased, as per our qualitative data.
The medical on-call handover takes place twice daily in all hospitals as shifts change. The GMC states that ‘doctors must contribute to the safe transfer of patients between healthcare providers’ and hence it is vital to have a structured, good-quality handover.1 Lapses in information in the handover lead to mistakes being made, which increase morbidity and mortality.2 Our QIP shows scope for improvement in discussing hospital bed capacity state at medical handover meetings for awareness of juniors, which can reduce length of hospital stay and improve patient flow in the current pressured NHS climate.3 Apart from increasing patient safety, good communication and teamwork, handover meetings provide an additional educational opportunity for doctors in training, and this should be notable.
- © Royal College of Physicians 2023. All rights reserved.
References
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- General Medical Council
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- Bywaters E
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- Ewbank L
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