Patient Handover Research Articles

Speech recognition technology in prehospital documentation: A scoping review

ObjectivesThe nature of paramedic workflows, where paramedics are responsible to provide care and chart concurrently, can result in incomplete or non-existent patient care reports on patient handover to the emergency department (ED). Charting delays and retrospective recollection of care may lead to patient information gaps, which can increase ED workload, cause care delays, and increase the risk of adverse events. Speech recognition documentation technology has the potential to produce complete patient care reports quicker and improve paramedic-to-ED handover. We performed a scoping review to determine paramedic perceptions and user requirements for speech recognition documentation technology. MethodsMEDLINE, Google Scholar, IEEE Explore, ProQuest, and CINAHL were searched from 2014 to March 2024. Criteria included studies focused on paramedics’ use or perceptions of speech recognition documentation technology. This review included studies conducted in the prehospital environment and adjacent agencies (i.e., ED, fire, police, military). ResultsThe review identified eight articles that met inclusion criteria. All eight articles were small focus group-based studies in laboratory settings published on or after 2020. Five studies were conducted in the United States, two in Switzerland, and one in Japan. Of the eight studies, five recommended further live environment testing of the technology examined, and three underscored the importance of a user-centred design. The top user requirements for speech recognition adoption was hands-free use, noise reduction technology, battery life, and word accuracy. All eight studies recommended further research and development of speech recognition documentation technology in the prehospital workflow. ConclusionThis scoping review has highlighted that while there is a growing interest in speech recognition documentation technology in the paramedicine workflow, more research is needed, especially with larger samples in a live environment. The user requirements and perceptions of speech recognition documentation technology in paramedicine must be better understood to design systems with high adoption rates.

Handover of intensive care patients

An effective patient handover is a core element of high-quality patient care. Communication during patient handover in the intensive care unit is particularly challenging due to the clinical complexity and rapid changes in patient trajectories, complex interdisciplinary and interprofessional interfaces, linguistic barriers, situational and structural disruptive factors, personnel stress factors as well as the communication and error culture of the teams. In addition to avoiding disruptive factors and creating optimal communication conditions and human resources, the use of standardized and structured handovers with the help of protocols and checklists, as recommended in the literature, plays a decisive role as part of a bundle of measures for effective and safe patient care.

The offload study: A prospective observational study of the time to offload a patient from an ambulance or helicopter into an emergency department or percutaneous coronary intervention centre

Introduction Providing an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance. Methods A prospective observational study was conducted at The Air Ambulance Service (TAAS) from August 2022 to February 2023. Consecutive emergency patients who were pre-alerted to hospital and arrived at an ED or Percutaneous Coronary Intervention (PCI) centre with an escorting air ambulance crew member were included. The offload time (time between hospital arrival and handover of the patient) was measured using a stopwatch. Results Data was available for 228 patients arriving at 18 hospitals and 6 helipads. The median offload time by road ambulance was 2 min 34 s. The range of helicopter offload times was from 4 min 20 s to 21 min 37 s, which mainly depended on the location of the helipad. Conclusion An additional 2–3 min should be added to the ETA by road ambulance. There is large variation in helicopter offload times depending on the helipad location (secondary/offsite helipad taking longer than a primary rooftop helipad or primary same-level helipads). HEMS services should review their own offload times at local sites to be able to provide a more accurate ETA.

Effectiveness of the Practice of Standardized Handover Process Using a Checklist in the Postanesthesia Care Unit: An Observational Study.

Patient handovers without any structured checklist may omit essential information that might have undesirable consequences for patients. We sought to determine the effectiveness of a structured postanesthesia care handover (PACH) checklist in the postanesthesia care unit (PACU) to reduce adverse clinical outcomes. A single-center, prospective, pre-postimplementation study was conducted. Moreover, post-PACH checklist implementation data were collected from 130 participants ( n = 65 in each group) by an independent observer. Data analysis was performed using the SPSS (25.0) version (IBM SPSS statistics). The Chi-square test was used to compare the dichotomous response. A statistically significant reduction in hypoxemia (21.5% vs. 0; P < 0.001) was observed in the postimplementation group. There were significant improvements in patient information ( P < 0.01), reduction in variations in hemodynamic parameters ( P < 0.01), and improvement in the quality of information transferred concerning surgical procedures ( P < 0.01). The number of phone calls to consultants was significantly lower in the PACH group. Implementation of the PACH checklist was associated with no hypoxemic events in PACU by improving the quality of communication. The implementation of a structured checklist in PACU should be mandatory in the postoperative intensive care unit.

Evaluation of the Handover Training Program Given to Nursing Students Using the Kirkpatrick Model: A Quasi-Experimental Observational Study.

Patient handover training given to nursing students is important to ensure patient safety. There are a variety of evaluation models that can be used to evaluate the impact of education in nursing, one of which is the Kirkpatrick model. This study aims to evaluate the patient handover training given to nursing students according to the Kirkpatrick model. A pretest and posttest design was used with a convenience sample of 33 nursing students. The training provided was evaluated according to the reaction, learning, behavior, and result levels of the Kirkpatrick model. In the study, data were collected by researchers observing students through face-to-face interactions and bedside observations using Handoff Evaluation Scale (Handoff CEX). It was found that 42.1% of the nursing students practiced verbal, 19.7% taped, and 36.8% bedside handovers before the training, while all the students practiced taped, verbal, and bedside handovers after the training. While the mean (SD) scores of patient handover (2.87 [0.95]) were at an insufficient level before the training, the scores after the training (7.12 [1.06]) increased to a high level. The difference between the mean patient handover scores before and after the training was statistically significant (P < .001). After the training provided in the study, it was observed that nursing students improved their patient handover levels and styles, handover participation, and information transfer. Patient handover training given to undergraduate student nurses can be evaluated using the Kirkpatrick model.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education

IntroductionInadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. MethodsA multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. ResultsHCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. ConclusionThis study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Simulation-Based Enhancement of Patient Safety During Intrahospital Transport of Trauma Patients With COVID-19: A Helipad Scenario.

Trauma resulting from accidents, violence, or war claims over five million lives annually, with traffic accidents and falls being predominant causes. The COVID-19 pandemic has posed unprecedented challenges in trauma care. Even though the number of injuries decreased during the lockdown period, the transportation of trauma patients became even more challenging due to concerns aboutinfection control and the need for enhanced protective measures. This simulation workshop was conducted in a controlled environment to test and refine protocols for the safe transport of trauma patients with COVID-19. Our goal was to develop comprehensive guidance on the intrahospital transportation of these patients, ensuring the highest level of patient care and safety. We detail a five-step approach from preparation to the pre-landing, initial assessment, patient transfer, and patient handover phases, emphasizing adherence to protocols, equipment readiness, and personal protective equipment (PPE) use. The primary issues we encountered were related to time management, the decision-making process for applying lifesaving procedures in an open environment, and the risk of cross-infection. The workshop underscored the importance of swift and coordinated care, balancing life-saving interventions with efficient transport to a definitive care facility.

Implementation and adoption of SOAP-M and SBAR at a German anesthesiology department – a single-center survey study

BackgroundChecklists are a common tool used in order to mitigate risks caused by human factors and can facilitate the safe induction of anesthesia as well as handovers. SBAR (Situation, Background, Assessment, Recommendation) is a checklist recommended by the WHO and DGAI for handovers, while SOAP-M (Suction, Oxygen, Airway, Pharmaceuticals, Monitoring) is a checklist for the induction of anesthesia. This study investigates the implementation and adoption of these two checklists.MethodsWe conducted a single-center online survey one year after the implementation of SOAP-M and SBAR at a university hospital’s anesthesiology department, using scales from three validated questionnaires to assess safety attitudes as well as the behavior of staff and the perceived usefulness of the checklists.ResultsStaff with a high score in general attitude towards patient safety, as determined by the safety attitudes questionnaire, considered both checklists useful additions to their work environment. Nurses and physicians (p = 0.102) as well as groups divided according to work experience (p = 0.077) showed no significant differences in using SOAP-M and SBAR. Perceived usefulness was significantly higher (p < 0.001) among users of the checklists, and the same goes for positive reinforcement (p < 0.001), social cues (p = 0.0215) and goal cues (p = 0.0252).ConclusionSOAP-M and SBAR are perceived as useful checklists for patient handovers and anesthesia induction by tertiary referral hospital’s employees with high score in general safety attitude and were therefore commonly used one year after their introduction. No significant difference in checklist adoption between occupations as well as groups divided according to work experience could be found. Perceived usefulness is significantly higher among users of the checklist, who feel using the checklists provides more support.

Design and construct of an assessment tool for the handover of critical patient the in urgent care and emergency setting

ObjectivesTo design and construct an assessment tool for the handover of critical patients in the urgent care and emergency setting. Research methodologyThis metric and descriptive study comprised two phases in accordance with the Clinical practice guidelines for A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist. In the first phase, the identification and selection of items related to the handover of critical patients were performed by consensus of a group of experts. The second phase consisted of two stages. In the first stage, the items were selected by applying the e-Delphi technique across two assessment rounds and in the second stage, the items were subjected a pilot test in a real critical patient handover scenario. Professionals from different disciplines and work areas (hospital and prehospital) caring for critically ill patients in the urgency and emergency setting participated in each of the phases. ResultsA total of 58 critical patient care, and urgent and emergency care professionals participated in the design and construction of the assessment tool. The initial list consisted of 14 categories and 57 items, which were reduced to 28 items grouped into five categories after the intervention of the participants. The content validity index (CVI) of the instrument was 0.966. ConclusionsThis study describes an assessment tool developed in Spanish-language designed to assess the handover of critical patients in the urgent care and emergency setting. This tool has a high CVI, and is the only currently available tool that consider all of the dimensions and characteristics of the handover process. Implications for clinical practiceThe assessment tool developed in this study could enable critical care professionals in their clinical practice to work in a systematic way, universalizing the handover of critically ill patients in the urgent care and emergency setting through scientifically proven guidelines.

Assessment of Patient Handover Process from Operating Room to Intensive Care Unit at Cardiovascular Surgery Hospital of Ain Shams University

Abstract Background Handovers of post-anesthesia patients to the intensive care unit are commonly unstructured and performed under time pressure. The cardiovascular patients are transferred directly to intensive care unit after the operation, as these vulnerable patients need more and faster care. Therefore, the handover processes are more susceptible to poor communication, loss of information and potential patient harm. Objective To identify the frequency of defects of current practice of healthcare providers during handover process from operating room to ICU after cardiovascular surgery and to determine the contributing factors that affect the transition of care process. Methods This descriptive Cross-sectional study was conducted after cardiovascular surgery the intensive care unit of Cardiovascular Surgery Hospital, one of Ain Shams University Hospitals between December 2021 to March 2022. A checklist was used to assess the performance of handover processes of 120 adult patients after cardiovascular operation, which included 8 main areas (Contributing factor, Pre-handover, Equipment and technology handover, Patient specific information, Anesthesia information, Surgical information, Duration of handover process, Distraction) Results The mean age of patients was 56.03 ± 10.77 years and most of them 85 (70.8%) were males. The median number of errors in pre-handover process was 0(0), patient specific information 3(1), anesthesia information 3(0), surgical information 4.5(2) and equipment handover 3(0). The mean duration of handover processes in minutes was 15.09 ± 5.69 (range 8–35) and 76 (63.3%) of the processes had distractions. There was no significant correlation between age, duration of surgery, duration of handover and number of errors regarding (pre- handover, patient information, anesthesia information, surgical information and equipment handover).The important items were not handed over at all(name of the patient, allergies to medication, estimated blood loss, medications given during surgery which need to be restarted) Conclusions and Recommendations The overall omission is low in spite of the expected to be zero, taking into consideration the type of procedures and the patient condition, so the critical situation need every elements must be fulfilled for patient safety and to avoid complications that may threat the patient life.

208 Head and Neck Surgical Oncology Handover Audit Using ‘RAAAIDDSS’ Method

Abstract Background Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes. Aim To audit the compliance of RAAAIDDSSS method. Method This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method. Results First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method. Conclusions UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.

Psychometric Analysis of the Spanish-Language Version of the Instrument for the Evaluation of Handovers in Critically Ill Patients in Urgent and Emergency Care Settings.

Background/Objectives: Patient handover is the process by which the responsibility for care is transferred from one health care professional to another. Given the lack of validated scales to assess the handover of critically ill patients, our aim was to evaluate the reliability and validity of the Instrumento de Evaluación de la Transferencia de Enfermos Críticos (IETEC) (English: Instrument for the Evaluation of Handovers in Critically Ill Patients). Methods: Psychometric analysis of the reliability and validity (construct, convergent, and discriminant) of the IETEC. This single-center study included professionals (nurses, physicians, and emergency medical technicians) involved in the care of the critically ill in urgent care and emergency situations. Results: We evaluated 147 handovers of critically ill patients. The KR-20 score was 0.87, indicting good internal consistency. Of the 147 handovers, 117 (79.6%) were classified as unsafe and 30 (20.4%) as safe. The model fit showed an acceptable construct validity (24 items and four factors: Identification, Communication, Quality, and Family). The Communication domain had the strongest correlation with the total scale (r = 0.876) while Family had the weakest (r = 0.706). The Communication and Family domains were closely correlated (r = 0.599). The IETEC reliably differentiated between safe and unsafe handovers, with a mean (SD) score of 26.3 (1.2) versus 19.0 (4.8), respectively. No significant differences (p = 0.521) in mean IETEC scores were observed between the physicians and nurses. Conclusions: These results show that the IETEC presents adequate psychometric properties and is, therefore, a valid, reliable tool to evaluate handovers in critically ill patients in urgent care and emergency settings.

Enhancing nursing students' clinical competency using a multi-patient simulation learning model: A randomized controlled study

BackgroundFor nurses, clinical competency is paramount in ensuring that patients receive safe, high-quality care. Multi-patient simulation (MPS) in nursing education is gaining attention, and evidence shows its suitability for real-life situations. MPS can be an effective solution for nurses' continuing clinical education. ObjectivesThis project compares the effectiveness of MPS (involving both a standardized patient and a high fidelity simulator) and a single high-fidelity simulation (single HFS; only involving a high fidelity simulator) for enhancing the clinical competency of nursing students. DesignA stratified, permuted, block randomized controlled study design was used.Settings and participants.Sixty undergraduate nursing students in years 3, 4, and 5 were selected to participate. Subgroups with each comprising three undergraduate nursing students from different years were formed. MethodsThe participants were randomized to receive either an MPS (intervention group) or single HFS (control group) for 1 day; they later received the same intervention after a 30-day washout period. One objectively measured questionnaire and two self-reported questionnaires were used to measure clinical competency: the Creighton Competency Evaluation Instrument (CCEI), Clinical Competence Questionnaire (CCQ), and Simulation Effectiveness Tool – Modified Questionnaire (SET-M). ResultsThe results revealed significant between-group differences. Specifically, the intervention group showed greater improvement than the control group in both the CCQ (linear contrast [d] = 71.4; 95 % confidence interval [CI] = 53.407, 89.393; P < 0.001) and CCEI total scores (d = 7.17; 95 % CI = 5.837, 8.503; P < 0.001). The SET-M results indicated that 85 % of the participants (n = 51) strongly agreed that they felt more confident about performing a patient handover to the healthcare team after the simulation. ConclusionsThe study findings indicated that both the MPS and single HFS effectively enhanced students' clinical competency. However, MPSs have superior educational outcomes relative to traditional single HFSs.

Factors Related to The Implementation of Handover in Hospital Inpatient Rooms

Handover is an oral communication of information about patients carried out by nurses at the change of shift. Inaccurate information in carrying out acceptance considerations can have a serious impact on patients. The aim of this literature review is to determine the factors associated with patient handover in hospital inpatient rooms. A literature search was carried out based on articles published between 2018-2023 according to the inclusion and exclusion criteria that had been determined using 1 data base, namely GoogleSchool. This literature search uses the PRISMA guideline in carrying out the screening process. From the search results, 2,420 articles were obtained. After carrying out the screening process, there were 3 articles that met the criteria and will be analyzed. Based on a study of 3 articles, it was found that the factors related to the implementation of patient handover in inpatient rooms in hospitals are: supervision, knowledge, peer support, communication, and organizational culture. Factors related to the implementation of handover patient consist of interna and external factors. It is hoped that hospitals will establish policies related to the management of handover patient in the form of standards and handover patient procedures that are applied in all hospital inpatient rooms, socialization and need supervision toward handover patient. As well as increasing nurses' knowledge through training. Keywords: factors, consideration, inpatient, hospital, nurse

Organizational culture and climate among hospitals in Jolo: Nurses’ perspective

This study assessed the l extent of organizational culture among hospitals in Jolo as perceived by nurses; extent of organizational climate among hospitals in Jolo as perceived by nurses Fiscal Year 2023. With 100 samples taken through non-probability sampling method via purposive sampling, and with the use of weighted mean, standard deviation, t-test for independent samples, One-way ANOVA, and Pearson’s r, this study reveals the following findings: 1) Of the 100 nurse-respondents, mostly are female within the age range of 30 years old &amp; below, mostly are staff nurse, with 5 years &amp; below of work experience, and mostly with contractual employment status; 2) On the average, positive organizational culture is provided by hospitals in Jolo; 3) On the average, positive organizational climate is afforded by hospitals in Jolo; 4) Generally, profile variables like age, gender, position, years of experience, and employment status do not significantly mediate in ways how nurse-respondents assessed the extent of organizational culture in hospitals in Jolo; 5) Generally, profile variables like age, gender, position, years of experience, and employment status do not significantly mediate in ways how nurse-respondents assessed the extent of organizational climate in hospitals in Jolo; 6) Generally, the group of nurse-respondents who assessed the extent of organizational Culture as Agree or with High Extent is mostly probably the same group of nurse-respondents who assessed the extent of knowledge Organizational Climate as Agree or with High Extent, respectively; 7) This study seems to support Edgar Schein’s (2010) Organizational Culture Model which posits that organizational culture consists of three levels: artifacts and behaviors, espoused values, and underlying assumptions. In the hospital environment, artifacts and behaviors refer to observable elements such as rituals, communication styles, and physical spaces found within the healthcare facility. The collaboration of nursing staff during patient handovers and the communication channels used can reflect the underlying organizational culture.

AB179. SOH24AB_275. Clinical audit on postanaesthetic patient handover to National Health Service protocol in University Hospital Limerick recovery room by anaesthetic non-consultant hospital doctors

AB179. SOH24AB_275. Clinical audit on postanaesthetic patient handover to National Health Service protocol in University Hospital Limerick recovery room by anaesthetic non-consultant hospital doctors

Discussion paper: implications for the further development of the successfully in emergency medicine implemented AUD2IT-algorithm.

The AUD2IT-algorithm is a tool to structure the data, which is collected during an emergency treatment. The goal is on the one hand to structure the documentation of the data and on the other hand to give a standardised data structure for the report during handover of an emergency patient. AUD2IT-algorithm was developed to provide residents a documentation aid, which helps to structure the medical reports without getting lost in unimportant details or forgetting important information. The sequence of anamnesis, clinical examination, considering a differential diagnosis, technical diagnostics, interpretation and therapy is rather an academic classification than a description of the real workflow. In a real setting, most of these steps take place simultaneously. Therefore, the application of the AUD2IT-algorithm should also be carried out according to the real processes. A big advantage of the AUD2IT-algorithm is that it can be used as a structure for the entire treatment process and also is entirely usable as a handover protocol within this process to make sure, that the existing state of knowledge is ensured at each point of a team-timeout. PR-E-(AUD2IT)-algorithm makes it possible to document a treatment process that, in principle, does not have to be limited to the field of emergency medicine. Also, in the outpatient treatment the PR-E-(AUD2IT)-algorithm could be used and further developed. One example could be the preparation and allocation of needed resources at the general practitioner. The algorithm is a standardised tool that can be used by healthcare professionals of any level of training. It gives the user a sense of security in their daily work.

An Analysis of Workplace-Based Assessments for Core Entrustable Professional Activities for Entering Residency: Does Type of Clinical Assessor Influence Level of Supervision Ratings?

The authors describe use of the workplace-based assessment (WBA) coactivity scale according to entrustable professional activities (EPAs) and assessor type to examine how diverse assessors rate medical students using WBAs. A WBA data collection system was launched at Oregon Health and Science University to visualize learner competency in various clinical settings to foster EPA assessment. WBA data from January 14 to June 18, 2021, for medical students (all years) were analyzed. The outcome variable was level of supervisor involvement in each EPA, and the independent variable was assessor type. A total of 7,809 WBAs were included. Most fourth-, third-, and second-year students were assessed by residents or fellows (755 [49.5%], 1,686 [48.5%], and 918 [49.9%], respectively) and first-year students by attending physicians (803 [83.0%]; P < .001). Attendings were least likely to use the highest rating of 4 (1 was available just in case; 2,148 [56.7%] vs 2,368 [67.7%] for residents; P < .001). Learners more commonly sought WBAs from attendings for EPA 2 (prioritize differential diagnosis), EPA 5 (document clinical encounter), EPA 6 (provide oral presentation), EPA 7 (form clinical questions and retrieve evidence-based medicine), and EPA 12 (perform general procedures of a physician). Residents and fellows were more likely to assess students on EPA 3 (recommend and interpret diagnostic and screening tests), EPA 4 (enter and discuss orders and prescriptions), EPA 8 (give and receive patient handover for transitions in care), EPA 9 (collaborate as member of interprofessional team), EPA 10 (recognize and manage patient in need of urgent care), and EPA 11 (obtain informed consent). Learners preferentially sought resident versus attending supervisors for different EPA assessments. Future research should investigate why learners seek different assessors more frequently for various EPAs and if assessor type variability in WBA levels holds true across institutions.

1882 Treatment Escalation Plans (TEP): benefits in adult in-patient facilities

Abstract Introduction Treatment escalation plans (TEP) guide level of life sustaining therapeutic interventions that should occur for each patient admitted to hospital and can prevent inappropriate and undignified interventions. However, implementation of TEP in routine clinical practise has been ad hoc partly due to the paucity of literature on their benefits. Our aim was to systematically review the literature to ascertain the use and benefits of TEP in adults. Methods A systematic search for studies reporting TEP use were performed in the databases OVID Medline, Embase, Scopus and Web of Science. Search terms were ‘Treatment Escalation Plan’ Treatment Limitation, ‘Therapy Escalation’, ‘Escalation of Care’, ‘Palliative’, End of Life’, ‘Advanced Care Plan’. Exclusion criteria included studies prior to 2007, systematic reviews, case reports and letters. Results 468 records were retrieved, 117 duplicates removed, 351 records were screened. 302 were excluded by date or relevance. Of 49 eligible records, 39 were excluded by criteria or unavailability of full text articles. 10 Studies using case control and quality improvement methodology conducted between 2010-2022 involving 1614 patients were subject to a narrative review. 8 different TEP proformas were used. All studies reported an increase in TEP use across all clinical settings and after each PDSA intervention ranging from 78%-100%. TEP reduced the frequency of non-beneficial interventions and was associated with an average saving of £220 per patient. Conclusions TEP lead to more frequent and proactive discussions with patients on ceilings of care and provide clear guidance to clinical staff out of hours, facilitate patient handover over successive shifts and enable proactive discussions with critical care. We identified the need for TEP to be successfully implemented in a unified manner across all healthcare facilities in order to improve patient care, reduce the burden of non-beneficial interventions and align with the NHS Long Term Plan.

The use of information technology to improve interdisciplinary communication during infectious diseases ward rounds on the paediatric intensive care unit

Prospective audit with feedback during infectious diseases ward rounds (IDWR) is a common antimicrobial stewardship (AMS) practice on the Paediatric Intensive Care Unit (PICU). These interdisciplinary meetings rely on the quality of handover, with high risk of omission of information. We developed an electronic platform integrating infection-related patient data (COSARAPed). In the mixed PICU of a Belgian tertiary hospital we conducted an observational prospective cohort study comparing patient handovers during IDWRs using the COSARAPed-platform to those with access only to conventional resources. The quality of handover was investigated directly by assessment if the narrative was in accordance with Situation-Background-Assessment-Recommendation principles and if adequate demonstration of diagnostic information occurred, and also indirectly by registration if this was only achieved after intervention by the non-presenting AMS team members. We also recorded all AMS-recommendations. During a 6-month study period, 24 IDWRs and 82 patient presentations were assessed. We could only find a statistically significant advantage in favor of COSARAPed by indirect evaluation. We registered 92 AMS-recommendations, mainly resulting in reduced antibiotic pressure. We concluded that the IDWR is an appropriate platform for AMS on the PICU and that the utilisation of COSARAPed may enhance the quality of patient handover.