Inner city care.

Abstract

<h3>Introduction</h3> This quality improvement project, run by three Foundation year 1 (F1) doctors, occurred at Torbay Hospital, a district general hospital in Devon England. The aim was to make the process of F1 Acute Reviews of unwell patients during weekend safer and more efficient. <h3>Method</h3> Over a 3-week period, the number of acute reviews F1s received via text or a phone call on Saturday and Sunday was collated to ascertain the percentage of verbal acute review handover. We surveyed and spoke to nurses and members of the Hospital-at-day-team to determine their feelings on the subject. <h3>Results</h3> After analysing the preliminary data, we requested that the Hospital-at-day-team call F1 doctors with acute reviews, reverting to text only if unable to reach the F1. We trialled this intervention for 3 weeks and improved verbal handovers of acute reviews from 5.6% (1/18 verbal) to 71% (22/31 verbal). This ensured a closed acute review loop could be created in 71% of cases. We define a closed acute review loop as a system in which a named doctor is aware of an acutely unwell patient (figure 1). <h3>Conclusions</h3> Due to our intervention, a named F1 was made aware acutely unwell patient within a short, known period, and thus could arrive in a timelier fashion ultimately improving patient care efficiency and safety. During this trial, we found that incomplete verbal SBARs were given to F1s, and routine reviews were inappropriately sent out as acute reviews. The Out of hours taskforce at the hospital trialled a weekend of clinical staff giving advice to nurses and HCAs requesting acute reviews to facilitate the initiation of nursing level interventions at an earlier stage in the acute review process; they also gave the F1 doctor a verbal handover of acute reviews. We are working with the clinical site managers to triage reviews, ensure continuity of verbal handovers.