Introducing a formal night-to-morning handover on the acute medical unit Princess Royal University Hospital (PRUH)

Interventions

Introduction of daily verbal and written handover using a formatted whiteboard, which identified all staff members, highlighted any unwell patients, priority tasks and potential staffing issues.

Use of a consultant cue-card to standardise the handover.

Feedback

Informal verbal feedback post cycle 1 – highlight overnight adverse incidents, hospital operational concerns and giving a learning point of the day to morning team.

Interventions

Improved visual clarity of whiteboard and development of laminated handover cue-cards produced and printed to guide succinct handover delivery by night team.

Remeasure

Repeat online survey re-sent to all junior doctors and consultants on AMU 6 months post cycle 2 interventions. Overall positive response to introduction of AMU morning handover: 90% agreed new handover safely identifies unwell patients to day team; 50% improvement in handing over to the relevant team; 40% suggested an electronic handover would be useful.

Sustainability

We plan to repeat further cycles and re-assess interventions, to appoint a handover champion, to embed the handover within inductions, to collect feedback from consultants and to involve senior nursing staff and hospital managers.

Strengths and limitations

It enabled the introduction and implementation of a simple, cost-effective, formal AMU morning handover at PRUH that follows elements of the BMJ's ‘good handover’ practice. It has shown demonstrable improvement in addressing trainees’ concerns. It follows the structure of a quality improvement project and involved three cycles with interventions reviewed after each cycle. Direct impact on patient safety was not measured as it did not use patient safety outcome measures.