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Addressing handover culture

Introducing a new, multi-disciplinary, team-based handover meeting

Published quality improvement report by BMJ

This project improved the quality of handover and reduced the length of time handing over and the number of distractions occurring during handover.

The general medicine department at the Royal Sussex County Hospital, Brighton has an ill-defined handover between the day and night team in the evening.

A two-hour overlap between the two shifts with no defined handover time within this results in a chaotic approach to handover which includes multiple individualised handovers between staff rather than a unified team approach.

The risks associated with handover include information not being handed over or being misunderstood which may lead to “serious breakdowns in the continuity of care, inappropriate treatment, and potential harm to the patient”.

When measuring the effectiveness of handover both qualitative and quantitative approaches were used to evaluate handover.

Key initial findings include the fact that mean handover length was approximately 70 minutes and there were around 14 distractions occurring in each handover with an average of 5.5 being due to additional conversations in the background of handover. An average of 15 tasks are handed over each night; the registrar witnessed 44% of tasks being handed over and the nursing night practitioner witnessed 0% of tasks being handed over.

In terms of the information being handed over, hospital number was handed over 70% of the time, admitting diagnosis 79% of the time, relevant comorbidities 31% of the time, and a time allocated for the task 17% of the time.

Patient name, location, outstanding task and active issue were handed over 90% or more of the time and tasks were allocated to a specific individual 90% of the time.

This data, along with the RCP’s “acute care toolkit”, were used to design a new handover meeting which would occur at a set time (8:00pm) every night in a set location. This location was moved away from the small doctor’s office to a large seminar room as it was hoped that moving away from the busy, working environment would promote an increased focus on the task of handing over rather than routine work and therefore reduce distractions.

This project has demonstrated that replacing an ad-hoc system of handover with a multidisciplinary, team-based approach to handover, not only improves the quality of handover but also reduces the length of time handing over and the number of distractions occurring during handover. Additionally, perceptions of the quality of handover within the department were also improved.

quoteBMJ Quality Improvement Reports publishes quality improvement work, original research and reviews. The online-only, open access journal covers all aspects of quality and patient safety in healthcare.