Handover System Research Articles

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care.

Patient handover is paramount for effective patient care and is often poorly documented or incomplete. North Bristol NHS Trust weekend handover proformas identify medical patients requiring weekend review. Many patients seen during on-call shifts are not handed over. Our aim was to develop Friday ward round proforma sheets for medical patients, to encourage clear documentation of management plans in order to improve handover of important information, particularly ceiling of care decisions.Questionnaires were completed by F1 doctors regarding current handover systems. Baseline data collected by on-call F1s included time of understanding a patient's ceiling of care decision, and difficulty of comprehension of medical notes. Repeat data were collected with novel proformas in situ. Multiple cycles were performed to refine the sheets and target problems arising in their use.Ninety-three percent of F1s wanted improved patient handover, with ceiling of care (87%) and management plans (73%) being the most difficult areas to understand. Time taken to ascertain ceiling of care decisions improved with the introduction of Friday handover proformas; mean time 153 seconds before and 5 seconds after. Clarity and documentation of management plans improved, with 50% improvement in ease of understanding medical notes.Results demonstrate that introducing Friday ward round proformas for medical patients improves communication between weekday and on-call teams, highlights current escalation of care plans, and leads to faster decision-making. Future plans include the introduction of a short educational session to the new F1 doctors and continued progress with introduction into hospital stationary.

QUALITY IMPROVEMENT PROJECT: DETECTING, INSTIGATING AND ASSESSING EFFECTIVE HANDOVER TECHNIQUES

Safe handover is integral to patient safety. Since the implementation of the European Working Time Regulations, doctors' working patterns have largely moved to a full shift system. Consequently, there is...

S121021 手渡しロボットシステムのための音声と手放し動作のタイミングに基づく手渡し動作モデル([S121-02]ヒューマンインタフェース(2))

Recently, it is expected that robots will play important roles such as social welfares and services in the home and office for the aging society. These robots must be able to cooperate with humans. One of the most important jobs of these robots is a handing to a human. The handing-over motion of the robot must be not only physically safe but also psychologically comfortable. Therefore, in this paper, we propose a handing-over motion model based on timings between voice greeting and release motion of humans. This model generates a motion in which a robot hands over an object to a human accompanied by a voice greeting. Furthermore, a hand-over robot system that uses the proposed handing-over motion model is developed. By sensory evaluation using the developed robot system, a timing between voice greeting and release motion which is preferred by humans is analyzed, and the effectiveness of the proposed model is demonstrated.

Improving medical SHO weekend handover at a tertiary referral centre.

The GMC states that, ‘You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients’ medical care…including effective hand-over procedures' [1].The medical weekend handover system at this tertiary referral centre involved multiple pieces of paper with no clear list of tasks, and no way to identify critically unwell patients. Patients could be missed from the ward round or could be difficult to identify under pressure. The authors felt this process could pose a threat to patient safety so decided to improve it.A questionnaire was distributed to all 11 medical SHOs with 100% response rate. Results showed that 72% thought the process was unstructured, 81% did not think the process was always safe, and 100% thought it could be improved. After discussions with senior medical management and with the approval of the trust audit committee, a new weekend handover proforma was designed, taking into consideration the results and comments from the questionnaire.The new proforma is accessible through a shared drive, which can be accessed by all medical SHOs in the hospital. Each team is able to copy their patients onto the combined ward-based list. There are columns for specific weekend jobs and registrar/SHO reviews. Any potentially unwell patients are highlighted in bold and discussed with the on-call SHO on Friday.All medical SHOs were given a post-implementation questionnaire after the new handover process had been in place for two months. Results of this showed that 100% of SHOs felt an improvement had been made, with 100% stating that the new system was more structured (64% always, 36% most of the time). The SHO's perception of patient safety increased from 81% generally unsafe, to 100% generally safe. The new handover has been well received and supported by the current SHO cohort. Improvements in the structure of handover have been made with perceived improvements in patient safety. Due to the success of the system, the handover proforma is being implemented in the trust's sister hospital.

Reduced emergency calls and improved weekend discharge after introduction of a new electronic handover system

To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends. Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of the Blue BARRWUE handover system at Geelong Hospital. Implementation of the Blue BARRWUE handover system and its components (updated working diagnosis, background, alerts, resuscitation status, requests, who to do what and when, updates and executable discharge plan). Presence of any written handover notes or updated working diagnoses in the BOSSnet clinical information system, content of handover notes, frequency of weekend discharges and medical emergency team (MET) calls before and after implementation. In the 12 months before implementation of the Blue BARRWUE handover system, 976 patients (47.98%) had a handover note in BOSSnet, versus 1646 patients (95.09%) in the 12 months after implementation (P< 0.001; rate ratio [RR], 20.75; 95% CI, 16.33-26.44). Before implementation, 289 patients (14.21%) were discharged over weekends, versus 353 patients (20.39%) after implementation, (P < 0.001; RR, 1.44; 95% CI, 1.25-1.65). MET calls were made for 152 general medical patients before implementation (7.47%), versus 95 general medical patients (5.49%) after implementation (P = 0.01; RR, 0.73; 95% CI, 0.57-0.94). The Blue BARRWUE system has sustainably improved written handover in our organisation and was associated with improvement in both patient safety and hospital efficiency.

PB17 Handover tool use in the emergency department

Objectives and BackgroundOngoing patient management in the Emergency Department involves the handing over of patients between medical and nursing staff. Ideally, this should enable the receiving staff to be as...

Effect of Audit and Feedback on Improving Handovers: A Nonrandomized Comparative Study

High-quality, shift-to-shift handovers by residents are critical to ensuring to patient safety. The 2011 Accreditation Council for Graduate Medical Education duty hour requirements have increased the number of handovers occurring daily, necessitating new approaches to this challenge. Research suggests standardized approaches, electronic systems, and education programs can improve the handover process. We conducted a 2-phase, observational study comparing an electronic handover system (experimental) in one clinical setting to a standard card-based system (control) at a second site. Outcome data included an objective assessment of the completeness and accuracy of handovers, and resident assessment of the handover systems. In phase 1, data were recorded at both sites and not shared with residents. In phase 2, data from the experimental system were used to provide standardized feedback to residents on the quality of their handovers. A total of 3184 individual patient sign-outs were evaluated during the 11-month period. Following introduction of a feedback intervention in the experimental arm, errors were present in only 5.2% of handovers, compared with 16.1% of controls (P < .001), and 67% of the 38 residents responding reported they perceived the experimental system as facilitating better patient care. Regular, real-time feedback through an electronic handover system can improve the accuracy and completeness of handovers in patient care.

Impact of a new electronic handover system in surgery

Accurate handover of clinical information is imperative to ensure continuity of patient care, patient safety and reduction in clinical errors. Verbal and paper-based handovers are common practice in many institutions but the potential for clinical errors and inefficiency is significant. We have recently introduced an electronic templated signout to improve clarity of transfer of patient details post-surgical take. The aim of this study was to prospectively audit the introduction of this new electronic handover in our hospital with particular emphasis regarding efficacy and efficiency. The primary surrogate chosen to assess efficacy and efficiency was length of stay for those patients admitted through the emergency department. To do this we compared two separate, two-week periods before and after the introduction of this new electronic signout format. Users were not informed of the study. Information recorded on the signout included details of the emergency admissions, consults received on call and any issues with regard to inpatients. ASA grade, time to first intervention and admission diagnosis were also recorded. Our results show that introduction of this electronic signout significantly reduced median length of stay from five to four days (P = 0.047). No significant difference in ASA grades, time to first intervention or overall admission diagnosis was obtained between the two time periods. In conclusion, this is the first study to show that the introduction of electronic signout post-call was associated with a significant reduction in patient length of stay and provided better continuity of care than the previously used paper-based handover.

Introduction of an electronic handover system at a district general hospital

Introduction of an electronic handover system at a district general hospital

Review: bringing patient safety to the forefront through structured computerisation during clinical handover

This review aims to examine critically, the methods and modes of delivery of handover used in contemporary health care settings and explore the feasibility of a computerised handover system for improving patient safety. Clinicians play a critical role in promoting patient safety, and the handover ritual is recognised as important in exchanging information and planning patient care. Communication failures have been identified as an important cause of adverse incidents in hospitals. Integrative literature review. Search of multiple electronic databases using terms: nursing handover, handoff, shift-to-shift reporting and change of shift report. To date, the focus of research has primarily been on the vehicle of the handover, rather than the content and processes involved in ensuring the reliability and quality of clinical information. Employing a computerised handover system in the clinical arena has the potential to improve the quality and safety of clinical care. Whilst the handover performed from shift-to-shift is a valuable communication strategy, ambiguities and incomplete information can increase the risks of adverse events. Given the importance of effective communication, its key link to patient safety and the frequency of nursing handover, it is imperative that clinical handover undergo increased scrutiny, development and research. This review underscores the challenge in clinical handover and recommends the use of technological solutions to improve communication strategies.

Out-of-hours GPs and palliative care-a qualitative study exploring information exchange and communication issues.

BackgroundOut-of-hours general practitioners (GPs) cover the community over a significant proportion of a given week, and palliative care patients are seen as a priority. Little is known about how well these GPs feel supported in their line of work and whether communication exchanges work well for the proportion of their patients who have palliative care needs. For this study, GPs who provide out-of-hours care were interviewed in order to explore factors that they identified as detrimental or beneficial for good communication between themselves, patients, relatives and other professionals, specifically to palliative care encounters.MethodsNine GPs were interviewed using face-to-face semi-structured interviews. All nine GPs worked regular out-of-hours sessions. Data from transcripts was analysed using Interpretative Phenomenological Analysis.ResultsA predominant theme expressed by GPs related to constraints within the system provided by the local private company owned out-of-hours provider. A strong feeling of 'being alone out there' emerged, with some GPs more willing to call for help than others, and others expressing their concern at access to pharmacies and medication being very inconsistent.Out-of-hours GPs felt left alone on occasion, unable to access daytime services and not knowing who to call for advice. Information hand-over systems from in-hours to out-of-hours with regard to palliative care were felt to be inadequate. Out-of-hours doctors interviewed felt left out of the care loop; handover sheets from specialist palliative care providers were a rarity.ConclusionsOut-of-hours services need to be mindful of the needs of the GPs they employ, in particular relating to the palliative care they provide in this setting. Other healthcare professionals should aim to keep their local out-of-hours service informed about palliative care patients they may be called to see.

Socio-technical challenges in implementing safe patient handovers.

Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. Drawing on three ethnographic case studies we identify and discuss socio-technical issues which must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover and data standards and system integration warrant ongoing research in socio-technical aspects of care handovers.

A Quantitative Study on Japanese Workers’ Awareness to Information Security Using the Data Collected by Web-Based Survey

Problem statement: The researches in the field of social sciences such as economics and business management were not conducted until around 2000. Particularly, there are few empirical studies on information security. Primary reasons among various ones are that there is no data on information security countermeasures and we cannot easily use the data even if the data exist. Though it is in such a research environment, it is necessary to accumulate the research from not only promotion of academic research but also the social role. In this study, the author quantitatively analyzed Japanese workers’ awareness to information security. Approach: The author examined whether or not there are differences of the workers’ awareness to information security based on various attributes by using Analysis Of Variance (ANOVA) based on non-parametric method. Results: It is found that Japanese workers’ awareness to information security is different in attributes such as organizational attributes and the education about information security countermeasures. Conclusion: The author suggested the necessity of enhancing information security education and introducing firm system such as authority handover system and/or stock option system in order to motivate to take the efficient information security countermeasures.

Nurse Practitioner-Based Sign-Out System to Facilitate Patient Communication on a Neurosurgical Service

Failure to communicate important patient information between physicians causes medical errors and adverse patient events. On-call neurosurgery physicians at the Toronto Western Hospital do not know the medical details of all the patients that they are covering at night because they do not care for the entire service of patients during the day. Because there is no formal handover system to transfer patient information to the on-call physician, a nurse practitioner-based sign-out system was recently introduced. Its effectiveness for communication was evaluated with preintervention-postintervention questionnaires and by recording daily logins. There was a statistically significant decrease in number of logins after 8 weeks of use (p = .05, Fisher's exact test), and the tool was abandoned after 16 weeks. Modifications identified to improve the system include the ability to sort by attending physician and to automatically populate the list with new patients. Effective communication is important for reducing medical errors, and perhaps these modifications will facilitate this important endeavor.

Handovers by the board.

A hospital ward has saved five hours a week by introducing a new handover system.

Handover in Psychiatric Settings: Is Change Needed?

Handover is a tradition in mental health settings and can occupy a significant amount of time each day, yet the topic has commanded limited attention in the psychiatric literature. Increasing staff changes and growing reliance on casual staff has heightened the need for the effective and efficient transfer of essential information, as staff will often find themselves in settings with unfamiliar patients. In this context, effective and timely handovers are crucial. The aim of this article is to examine handover and consider how it may be used optimally to enhance service delivery. To reduce information loss and increase accuracy, verbal handover could be supplemented with computer-generated patient data. This combination will ensure face-to-face interaction remains and perhaps decrease time spent unproductively. Further research is necessary to evaluate such a handover system.

Development of electronic software for the management of trauma patients on the orthopaedic unit

Introduction Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. Methods Data was prospectively collected and analyzed using the SPSS 14 ® statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. Results With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% ( p < 0.0001) and missing patient location from 18.6% to 3.6% ( p < 0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% ( p < 0.0001) and from 11.7% to 0.8% ( p < 0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% ( p < 0.0001) and from 13.7% to 1.1% ( p < 0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was ‘closed’ or ‘open’, whereas in the electronic group this information was evident in all 357 patients ( p < 0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% ( p < 0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. Conclusions The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.

Implementation and Performance Evaluation of Two Fuzzy-Based Handover Systems for Wireless Cellular Networks

Wireless mobile networks and devices are becoming increasingly popular to provide users the access anytime and anywhere. We are witnessing now an unprecedented demand for wireless networks to support both data and real-time multimedia traffic. The wireless mobile systems are based on cellular approach and the area is covered by cells that overlap each other. In mobile cellular systems the handover is a very important process. Many handover algorithms are proposed in the literature. However, to make a better handover and keep the QoS in wireless networks is very difficult task. For this reason, new intelligent algorithms should be implemented to deal with this problem. In this paper, we carried out a comparison study of two handover systems based on fuzzy logic. We implement two Fuzzy-Based Handover Systems (FBHS) called FBHS1 and FBHS2. The performance evaluation via simulations shows that FBHS2 has better behavior than FBHS1 and can avoid ping-pong effect in all simulation cases.

Implementation and Performance Evaluation of Two Fuzzy-Based Handover Systems for Wireless Cellular Networks

Implementation and Performance Evaluation of Two Fuzzy-Based Handover Systems for Wireless Cellular Networks

A Speed‐Aware Handover System for Wireless Cellular Networks Based on Fuzzy Logic

Presently, the wireless mobile networks and devices are becoming increasingly popular to provide users the access anytime and anywhere. The mobile systems are based on cellular approach and the area is covered by cells that overlap each other. In mobile cellular systems the handover is a very important process, which refers to a mechanism that transfers an ongoing call from one Base Station (BS) to another. The performance of the handover mechanism is very important to maintain the desired Quality of Service (QoS). Many handover algorithms are proposed in the literature. However, to make a better handover and keep the QoS in wireless networks is very difficult. In this paper, we propose a speed‐aware handover system based on fuzzy logic. The proposed system has 3 subsystems. The performance evaluation via simulations shows that proposed system has a good handover decision.