861 Getting the Surgical Handover Right: A Closed-Loop Audit

Abstract

Abstract Aim The European Working Time Directive has led to a reduction in hours worked by junior doctors and subsequently increased the number of handovers between colleagues. Ineffective handovers introduce the opportunity for clinical error and adversely affect patient safety. We sought to improve the quality of patient handovers in a busy surgical department, by assessing compliance with a twelve-point guideline from the Royal College of Surgeons (RCS) as the gold standard. Method An audit was performed across a seven-day period. For each patient discussed during the morning or evening handover, compliance was measured according to twelve domains pertaining to a patient’s admission as per RCS recommendations (e.g., diagnosis, location, relevant investigation results). Following intervention with a ‘safe handover’ checklist, we repeated the audit across a subsequent seven-day period. Secondary outcomes, such as environmental and human factors, were also assessed by a junior team member. Results A total of 28 handovers, incorporating 337 patients, were included. Following implementation of the checklist, compliance improved across most domains—particularly with highlighting the necessity for an additional review (33.3% vs. 91.0%) and the handover of outstanding tasks (31.5% vs. 84.3%). Compliance with discussion of resuscitation status remained low (7.0% vs 9.2%). Improvements were noted with environmental and human factors, including performance of team introductions and the opportunity to raise concerns. Conclusions We have demonstrated an improvement in the quality of patient handovers as per RCS guidance following the implementation of a handover checklist. Further interventions are warranted to improve handover of resuscitation status.