Abstract
Clinical Handover has been identified as one of the most high-risk processes within medicine. Inadequate handover is a significant cause of avoidable adverse events across many hospitals. A likert-survey of the weekend handover system at a district general hospital demonstrated significant dissatisfaction amongst junior doctors. Intending to improve patient safety and reduce stress for on-call junior doctors, a weekend handover proforma was compiled according to the Royal College of Physicians and Surgeons guidelines. The proforma was trialed on six medical wards for six months with a before and after questionnaire being sent to doctors on the wards involved to determine the proforma’s merits on a scale of 1 (least effective) to 10 (most effective). Reports subsequent to implementation demonstrated a 67% increase ease of identifying outstanding weekend jobs. 57% of doctors reported better understanding of their patient’s diagnosis and management plan and 53% stated it was easier to identify the patients that required regular medical review over the weekend. Results also highlighted a 55% reported an increase in safety of weekend handovers (p<0.01). A closed loop audit of handover practice through the use of a standardised proforma showed improved quality, detail and consistency of handovers. The reduction in stress for junior doctors managing unknown patients with a clear concise plan, directed by a senior from the parent team during the week, has improved patient safety and doctor satisfaction.
Highlights
Clinical Handover has been identified as one of the most high-risk processes within medicine
The General Medical Council's Good Medical Practice states that achieving an effective handover is the duty of every doctor [2]
30 doctors completed the electronic survey at baseline. 19 doctors completed the survey after the weekend handover proforma had been in use for 6 months
Summary
Handover is defined as the system by which the responsibility for immediate and ongoing care is transferred between healthcare professionals [1]. The General Medical Council's Good Medical Practice states that achieving an effective handover is the duty of every doctor [2]. The NHS has adhered to the European Working Time Directive since 1998. Doctors are limited to working a maximum of 13 h per shift, which means that they are no longer able to provide continuous care for their patients [3]. The implementation of the junior doctor's contract has seen a change in working patterns. These changes create a significant need for effective handover to ensure continuity of care and by proxy patient safety
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