Electronic Handover System Research Articles

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Evaluating Psychometric Properties of the Sultan Bin Abdulaziz Humanitarian City (SBAHC) Nurses' Electronic Handover Tool.

Handover is crucial during the transfer of patient care between healthcare professionals.Successful handover maintains patients' safety and high-quality care. The electronic handover of patients' information is achievable, feasible, and potentially improves the quality of patient care. However, the introduction of the electronic handover is relatively recent and challenging for healthcare providers, especially nurses. Since Sultan Bin Abdulaziz Humanitarian City (SBAHC)has recently implemented an electronic handover system among nurses, the main aim of the current study was to develop a tool to assess the perception and barriers to electronic handover systems among nurses working at SBAHC and evaluate its psychometric properties. The tool content and face validity were assessed by the content validity ratio (CVR). Exploratory and confirmatory factor analysis were used as validity methods, while the test-retest and inter-item consistency were used as reliability measures. The sample size was planned as five times the number of questions and a total of 200 nurses participated in the study. The criteria required for factor analysis were met as indicated by the results of the Kaiser-Mayer-Olkin test and Bartlett's test of sphericity. The reliability results showed a Cronbach's alpha coefficient ranging from 0.858 to 0.910 for the perception subscale and from 0.564 to 0.789 for the barrier subscale, and an overall interclass correlation of 0.986, p<0.001. The developed SBAHC electronic handover tool was valid and reliable, and it is advisable to consider it at the initial stages of implanting an electronic handover system to identify obstacles that are faced by the staff to be considered and addressed by the higher management.

Requirements for an electronic handover system for interprofessional collaboration between psychotherapists and occupational health professionals – a qualitative study

BackgroundAn electronic handover system provides a potential way to bridge the interface between psychotherapy and occupational health. This qualitative study therefore aimed assessing (1) content-related and (2) functional requirements that psychotherapists and occupational health professionals expect from an electronic handover system to exchange relevant information about their patients with common mental disorders.MethodsFive focus groups with psychotherapists and occupational health professionals (occupational physicians and members of company integration management) were conducted via video conference using an interview guide. The focus groups were transcribed and content-analysed using MAXQDA.ResultsWith regard to content-related requirements, information that serve to assess employee’s ability to work was described as particularly relevant by occupational physicians and members of company integration management (e.g. restrictions in certain work areas or ability to work under time pressure). Psychotherapists indicated that information about the employee’s working conditions is particularly relevant. This includes description of work tasks or conflicts at the workplace. Concerning functional requirements, all professional groups attached importance to data security and functions to improve communication and collaboration (e.g. the use of standardised handover forms).ConclusionThis study provides insight into the desired content-related and functional requirements by psychotherapists, occupational physicians and members of company integration management for an electronic handover system. However, the theoretical and practical development of such a system requires several additional steps, such as the involvement of further relevant stakeholders (e.g. patients, software developers).

WE3.13 Friday Handover Flow

Abstract Aims Handover between teams is a requirement between colleagues to ensure patient safety. An electronic weekend handover Friday noon with the whole surgical team was implemented in 2017. This is the second cycle to close the loop. Methods The implementation of ‘Careflow’ software had all been initiated in 2017 to modernise handover from paper to e-handover. Anonymised questionnaires were sent to all surgical doctors 6 months following the initial intervention. An additional intervention of a Friday afternoon handover prior to the weekend was started following this. For the second cycle a similar questionnaire was distributed to observe whether the changes have been sustained and the impacts beneficial. Results From the first cycle 97% felt e-handover was better than paper handover. Comparing first and second cycles; 97% vs 80% reported adequate handover time, 97% vs 57.1reported handover incorporated into the working day, 42% vs 97.2% reported handover usually consultant led, 41% vs 48.6% were aware of RCS handover guidelines 81% vs 85.7% reported ‘Caredlow’ as having a positive impact. Overall 91.1% of staff were more than 60% satisfied with Friday midday weekend handover, and 100% wanted the practice to continue. Conclusions A prioritised handover, dedicated room, adequate time and senior presence are all required for an effective handover. To modernise and improve continuity of care, an electronic handover system is a positive, effective tool. In addition a Friday noon handover prior to the weekend enables the modern NHS to provide the best and safest practice for our patients.

781 IMPROVING THE QUALITY OF DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR) FORM COMPLETION

Abstract Introduction The completion of a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) form represents an important part of patient care. However, this can be a sensitive process that has gained national media interest. The aim of this Quality Improvement (QI) Project was to improve the quality of DNACPR form completion in a Care of the Elderly Department. Methods The QI project ran from May 2019 to January 2021 and was overseen by a multi-disciplinary team (including patient representation). DNACPR forms on the Care of the Elderly wards were audited monthly against 7 standards which correspond to key sections on the DNACPR form. During the data collection process, interventions were implemented using Plan-Do-Study-Act cycles. Interventions included: appointing ‘DNACPR Champions’ to complete monthly audits and provide personalised clinician feedback, the introduction of a new mandatory e-learning module, the creation of an alert system on nerve centre (the Trust’s electronic handover system) and the development of new DNACPR patient information including webpage development, videos and leaflets. Results The project has led to sustained improvements in majority of the 7 standards. The biggest improvements were seen in the inclusion of a review date, correct completion of the mental capacity assessment and the use of patient information leaflets. The documentation of discussions with patient and relatives remained below the audit standards and was largely unchanged during the QI project. Conclusion A multi-disciplinary and multi-faceted QI approach has shown to improve the quality of DNACPR form completion. Further work is needed to continue this process and a focus on staff training and ward-level processes will be the priority.

Improving the quality of weekend medical handover on non-receiving medical hospital wards

IntroductionHandover is the system by which the responsibility for immediate and ongoing care is transferred between healthcare professionals and can be an area of risk. The Royal College of Physicians...

Improving Clinical Handover on an Electronic Communication Platform: A Quality Improvement Project.

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.

67 Nutritional Assessment of Patients Admitted To “Adult Burns Unit” At Southmead Hospital from April To August 2017

Abstract Introduction Nutritional support is an integral part of Burns management. Local guidelines for malnutrition screen are available at Southmead Hospital. Aim Audit was aimed at compliance of malnutrition screen for all admissions to “Adult Burns Unit” to the local guidelines. Method A retrospective data of baseline and weekly malnutrition screen was collected and analysed for 106 patients between April and August 2017. These findings were compared to the following local guidelines; Results Of 106 patients, most (n = 72) had &amp;lt;5% TBSA burn. 9 were resus burns (TBSA &amp;gt;15%). 50 patients stayed less than a week while 34 discharged within 24hrs. 20 stayed longer than seven days. Compliance of recording weight on admission was 46.2% while weekly assessment 10%. Height and BMI were measured for 24.5% of admissions. 81% of patients had admission bloods and 19 out 20 staying longer than a week had weekly bloods. All major burns were referred to dietician. Conclusions Assessment of %TBSA, admission and weekly bloods, and dietician referral were areas of good practice. However, compliance with recording weight and height on admission did not meet the Trust target of 85% We recommended a checkbox for weight and height on admission in Trust’s electronic handover system, monitor at weekly burns MDT and re-audit.

Measuring Nurses' Transition to Electronic Handover: Validation of the Perception and Adaptation Readiness of Electronic Handover Systems Scales.

The transition from traditional handover methods to electronic handover is extremely stressful to nurses. This psychometric evaluation study tested the validity and reliability of the perception and adaptation readiness of electronic handover system scales for hospital nurses. A total of 253 Taiwanese nurses from a medical center participated in this study from January to March 2018. The perception and adaptation readiness of electronic handover system scales were self-developed, and content validity was tested via content validity index of the scale. Exploratory factor analysis and confirmatory factor analysis were utilized to test construct validity, while reliability was tested by Cronbach's α coefficient. Four factors explained 50.77% of the total variance in the perception of electronic handover system scale. Three factors accounted for 53.43% of the total variance in the adaptation readiness of electronic handover system scale. The confirmatory factor analysis results indicated a three-factor construct for both scales. Cronbach's α coefficients were 0.83 and 0.91 for the perception and adaptation readiness of the electronic handover system scale, respectively. The scales could be used to assess nurses' perceptions and adaptation readiness of electronic handover, while the assessing result serves as a reference for implementing educational and supportive interventions to facilitate adaptation in nurses.

Development and implementation of electronic medical handovers across psychiatric hospitals: quality improvement initiative

A lack of integration between internal processes and failure to use the full potential of information technology (IT) systems is common in psychiatric hospitals. We aimed to reduce the number...

Improving patient care by designing and implementing an electronic handover system

Improving patient care by designing and implementing an electronic handover system

The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation.

BackgroundPatient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as “track and trigger,” or rapid response systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient’s bedside, improves visibility of patient data, and streamlines communication within clinical teams.ObjectiveThe aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology.MethodsA total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom.ResultsRoll-out of eObs was associated with approximately 10% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7% to 25.6%). More time was spent at the nurses’ station (6.6% to 41.7%). Patient contact time was more than doubled (2.9% to 7.3%).ConclusionsSince deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians.

MedE-Handover: Development of an electronic handover system to improve the safety and reliability of weekend handover on medical wards in a major acute teaching hospital

This project aimed to develop a robust and effective handover system to standardise the transfer of information between wards and out-of-hours clinicians, thus improving continuity of care and patient safety on medical wards. Electronic handover tools have been advocated as a potential strategy for enhancing the quality of handover. This project saw the design of a locally peer-reviewed Microsoft Excel database entitled ‘MedE-Handover’ which included scripts allowing semi-automation and standardisation of handover data. Replacing uncoordinated handwritten notes previously compiled separately by …

An Electronic Handover System to Improve Information Transfer for Surgical Patients.

Proper clinical transfers of patient care (known as handovers) are important to patient safety. The aim of this study was to investigate the efficacy and satisfaction of an electronic system for clinical transfers of patients with complex surgical procedures. The design was a single-center observational study auditing the handover process. The electronic handover system combined with an electronic health record system was developed to help verbal handover. The system has a checklist to guide the structured handover process and provided information from the health record system. With the system, the elapsed time for surgical handover decreased from 10.5 to 5.4 minutes. The questionnaire analysis showed that clinician satisfaction with surgical handover increased from 69.4% to 79.3%, and the perception of communication completeness increased from 67.2% to 81.6%. The electronic handover system improved communication for the transfer of care for surgical patients.

Implementing an electronic clinical handover system in a university teaching hospital.

Clinical handover is defined as inter-clinician communication occurring at care interfaces. In this study, we analyse the clinical outcomes and physician attitudes associated with the implementation of a electronic clinical handover system in our medical department. The aim of this project was to introduce a reliable, standardised, reproducible method of communicating information regarding inpatients within our medical department. We also sought to assess the attitudes of physicians within our department to medical handover. We designed and implemented an electronic handover template with a protocol to guide staff as to its use. Handover was audited weekly. In addition, we surveyed attitudes of doctors to handover before and after our handover pilot. An average of 32 patients were handed over each week. Compliance with mandatory handover of ICU/CCU patients averaged at 59%. Extrapolating our pilot results for the year would result in approximately 1655 handover events per annum in our department. One hundred percent of physicians surveyed felt that documentation of handover was beneficial, and staff satisfaction with handover improved after initiation of the pilot (81 vs 24%, p=0.000914). While 64% of staff were concerned that typed electronic handover would increase their workload, only 6% of the post pilot survey group felt that it did increase workload significantly. Electronic clinical handover is feasible and practical within the Irish healthcare system. In addition, it was found in our study to be attractive and effective to physicians without increasing their workload.

The use of Microsoft Excel as an electronic database for handover and coordination of patients with trauma in a District General Hospital

Communication between healthcare professionals is a key aspect in patient safety especially when dealing with patients with musculoskeletal trauma. The change of junior doctors’ working patterns within the last decade...

Improving patient safety: The impact of an outpatients' electronic handover system in a tertiary dermatology department.

Electronic medical records (EMR) can improve quality healthcare, patient safety and streamline workflow to improve efficiency of a department. Despite the known benefits and difficulties of EMR systems, there is limited data on the impact and definable effectiveness it can have within a dermatology unit. We present an outpatients' EMR known as an electronic handover system (EHS) from its inception, delivery and audit of its use in evaluating the true impact. An audit of the EHS was conducted from 1 March to 31 August 2014. Quantitative data evaluating the type of jobs entered and completed, overdue tasks, patient workload and phone consultations were conducted. Qualitative data was assessed via a pilot survey assessing users' perspectives of the EHS evaluating communication, clinician-patient relationship and administrative tasks. Altogether 754 jobs were entered for 411 dermatology outpatients using the EHS. Most tasks concerned following up bloods and swabs (38%) or biopsies (36%). Overall, 51 jobs were not completed by the specified due dates and 188 phone consultations were performed. Compared with pre-EHS data, clinic review patients fell by 16%, with a modest increase (2%) in the number of new patients seen. The survey results show that most respondents believed that EHS improved communication, did not affect the clinician-patient relationship and they were more confident in their practice knowing there was a recording system for follow up. The dermatology EHS has provided a reliable system for following up all outpatient results. The potential benefits range from clinical, organisational and health research, which, from our experience, demonstrates improved patient follow-up care.

Implementing an electronic patient handover system.

Clear communication among health-care teams is paramount for safe patient care and effective handover. Advances in information technology have led to an increased use of electronic systems within modern health care. This quality improvement project introduced an electronic patient handover system that was intended to improve the accuracy of patient handover lists and be readily available to all members of the health-care team. A quality improvement project was undertaken to assess the effect of introducing an electronic patient handover system on maintenance workload and list accuracy. List errors were common before the introduction of the electronic patient handover system, commonly patient location or a patient being incorrectly omitted from the list. These errors decreased significantly after the introduction of the electronic system (P<0.005 and 0.04 respectively). The workload associated with its maintenance also decreased (P<0.005) because many data fields were pre-populated by the software. This resulted in fewer instances of patients being missed on ward rounds (P<0.04). Through modifying existing information technology infrastructure, a centrally maintained, widely accessible electronic handover system was introduced. This reduced the workload associated with maintaining handover lists and the rate of errors.

Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice.

Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary. In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services. An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention. 1466 patients were admitted as emergencies during the study period. 58% (850) were male and median age was 48years (0-100). Average length of stay was 5days (range 1-125). 327 patients (22.3%) required operative intervention. The most commonly performed procedure was appendicectomy (52.5%). 48 (3.3%) patients were transferred to other hospitals. 131 (8.9%) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound. Almost 80% of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.

Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability.