Abstract
BackgroundNational guidance stipulates the essential components of a safe handover. Shift-based work and the COVID-19 pandemic has led to an increased turnover and re-deployment of staff into new clinical areas, creating challenges in delivering effective handovers.AimThe aim of this quality improvement project (QIP) was to improve adherence to a local standardised handover proforma to improve the quality and consistency of handovers.MethodsHandovers were assessed by measuring the completion rates of the essential components of a safe handover as outlined in the national guidance. Data were collected from an electronic handover system which follows the Situation, Background, Assessment and Recommendations (SBAR) structure, and percentage completion rates obtained for each component assessed. Following baseline measurement, four Plan-Do-Study-Act (PDSA) cycles were completed between August 2020 and February 2021 across two junior doctor rotations and during a COVID surge rota.ResultsA total of 710 handovers were assessed across the four PDSA cycles. There were overall improvements in the percentage completion rates of each component compared to baseline: Under ‘Situation’, admission dates increased by 13.7%, estimated discharge date by 33.3% and 100% completion rate maintained for the presenting complaint. Under ‘Background’, past medical history remained static, with a 12.1% increase in documentation of a social history. Under ‘Assessment’, escalation status increased by 335%, issues list by 242% and important updates by 35.2%. Under ‘Recommendations’, completion rate for plans was maintained at 100%.ConclusionsOur findings demonstrated an overall improvement in the majority of components of the handover proforma. Challenges remain with the rotation of junior doctors through different specialties leading to a loss of institutional knowledge and reduced longevity of the intervention’s effect, exacerbated by the introduction of the COVID surge rota. A long-lasting improvement may require a shift to a completely electronic patient records system (ePR) which incorporates a handover tool.
Highlights
COVID-19 is one of the greatest challenges faced by the National Health Service (NHS) with significant implications for clinician-to-clinician handovers of patient information
Data were collected from an electronic handover system which follows the Situation, Background, Assessment and Recommendations (SBAR) structure, and percentage completion rates obtained for each component assessed
There were overall improvements in the percentage completion rates of each component compared to baseline: Under ‘Situation’, admission dates increased by 13.7%, estimated discharge date by 33.3% and 100% completion rate maintained for the presenting complaint
Summary
COVID-19 is one of the greatest challenges faced by the National Health Service (NHS) with significant implications for clinician-to-clinician handovers of patient information. Large numbers of staff were redeployed throughout the NHS with changes in shift patterns, including the introduction of COVID surge rotas. The implementation of reverse-transcriptase polymerase chain reaction (RT-PCR) as a primary diagnostic and triaging tool contributed to an increase in the frequency of patient transfers between wards based on their COVID-19 status, often without direct handovers between the clinicians. Handover is an essential component of good patient care and ensures continuity of care. National guidance stipulates the essential components of a safe handover. Shift-based work and the COVID19 pandemic has led to an increased turnover and re-deployment of staff into new clinical areas, creating challenges in delivering effective handovers
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