Improving Medical Handover Using a Structured Handover Algorithm

Document Type : Original Article

Authors

1 Gastroenterology, Chelsea and Westminster NHS Foundation Trust, United Kingdom

2 General Medicine, Southend University Hospital, United Kingdom

Abstract

Introduction:
Handover is an important part of clinical practice and its failure is a major preventable cause of patient harm. With increasingly varied work patterns for all healthcare professionals, ensuring good and effective handover is paramount. Guidance has been created to highlight key handover principles. However, clinical surveys show wide variability between hospitals with limited or no defined handover processes.
 
Materials and Methods:
A single-centre quality improvement project with the implementation of a structured handover algorithm was performed, over five successive Plan-Do-Study-Act (PDSA) cycles. The inclusion of key elements identified in the literature as being important for effective handover were measured. These elements were assessed and monitored after the implementation of the structured handover algorithm and further interventions, including direct algorithm demonstration and change of handover location, as part of sequential PDSA cycles, following medical team (consultants, junior doctors and specialist nurses) consensus.

Results:
The baseline assessment of the hospital’s handover processes showed them to lack key handover elements. Through the introduction of the handover algorithm, the handover process improved significantly. Following the interventions all but two key handover elements were present in 100% of handovers with the two further elements present in at least 75% of handovers. These findings were sustained over five successive PDSA cycles.
 
Conclusion:
A structured handover algorithm improves handover practice. The structured framework of the algorithm acts as an aid, avoiding key elements from being missed and imprinting them into routine handover practice. The improvement methodologies and interventions of this study can potentially benefit further clinical settings and be adapted accordingly.

Keywords

Main Subjects

References

  1. Royal College of Physicians. Acute care toolkit 1 Handover May 2011. 2011; Available from: https:// www. rcplondon. ac. uk/sites/ default/ files/acute-care-toolkit-1-handover.pdf
  2. Pezzolesi C, Schifano F, Pickles J, Randell W, Hussain Z, Muir H, et al. Clinical handover incident reporting in one UK general hospital. International Journal of Quality in Health Care. 2010; 22(5):396–401.
  3. General Medical Council. National training survey 2013 : concerns about patient safety. 2013.
  4. General Medical Council. National training survey 2014: concerns about patient safety [Internet]. 2014. Available from: https:// www. gmc-uk.org/ National_training_ survey_ 2014_ key_ findings_ report_ 1114. pdf _58504492.pdf
  5. Walton H, Munro W. Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting. BMJ Qual Improv Rep. 2015; 4(1):u206069.w2989.
  6. Michael E, Patel C. Improving medical handover at the weekend: a quality improvement project. BMJ Qual Improv Rep. 2015; 4(1): u 207153. w2899.
  7. Mehra A, Henein C. Improving hospital weekend handover: a user-centered, standardised approach. BMJ Qual Improv Rep. 2014; 2(2):u202861.w1655.
  8. Mughal Z, Al-Jazieh I, Zaidi H. Development of a proforma to improve quality of handover of surgical patients at the weekend. J Eval Clin Pract. 2019; 25(3):456–62.
  9. Akhunbay-Fudge CY, Buss I, Ward A, Snead C, Cole M, Coulter A. Improving handover of patient care using a new weekend proforma with a focus on ceiling of care. BMJ Qual Improv Rep. 2014; 3(1):u203623.w1804.
  10. Ogrinc G, Davies L, Goodman D, Batalden P, David off F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016; 25(12): 986–92.
  11. Devlin MK, Kozij NK, Kiss A, Richardson L, Wong BM. Morning Handover of On-Call Issues: Opportunities for Improvement. JAMA Intern Med [Internet]. 2014 Sep 1; 174(9):1479–85. Available from: https://doi.org/10. 1001/ jamainternmed. 2014.3033
  12. Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, et al. How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation. 2018; 138(2): 154–63.
  13. Soar J, Deakin CD, Nolan JP, Perkins GD, Yeung J, Couper K, et al. Adult advanced life support Guidelines [Internet]. 2021 [cited 2022 Dec 1]. Available from: https:// www. resus. org.uk/ library/2021-resuscitation-guidelines/adult-advanced-life-support-guidelines.
Journal of Patient Safety & Quality Improvement
Volume 11, Issue 1
January 2023
Pages 3-11

Files

Share

How to cite

Statistics