Standardized Handover Research Articles

Improved patient safety with a simplified operating room to pediatric intensive care unit handover tool (PATHQS).

Patient handover is a crucial transition requiring a high level of coordination and communication. In the BC Children's Hospital (BCCH) pediatric intensive care unit (PICU), 10 adverse events stemming from issues that should have been addressed at the operating room (OR) to PICU handover were reported into the patient safety learning system (PSLS) within 1 year. We aimed to undertake a quality improvement project to increase adherence to a standardized OR to PICU handover process to 100% within a 6-month time frame. In doing so, the secondary aim was to reduce adverse events by 50% within the same 6-month period. The model for improvement and a Plan, Do, Study, Act method of quality improvement was used in this project. The adverse events were reviewed to identify root causes. The findings were reviewed by a multidisciplinary inter-departmental group comprised of members from surgery, anesthesia, and intensive care. Issues were batched into themes to address the most problematic parts of handover that were contributing to risk. A bedside education campaign was initiated to familiarize the team with an existing handover standard. The project team then formulated a new simplified visual handover tool with the mnemonic "PATHQS" where each letter denoted a step addressing a theme that had been noted in the pre-intervention work as contributing to adverse events. Adherence to standardized handover at 6 months improved from 69% to 92%. This improvement was sustained at 12 months and 3 years after the introduction of PATHQS. In addition, there were zero PSLS events relating to handover at 6 and 12 months, with only one filed by 36 months. Notably, staff self-reporting of safety concerns during handover reduced from 69% to 13% at 6 months and 0% at 3 years. The PATHQS tool created in this work also spread to six other units within the hospital as well as to one adult teaching hospital. A simplified handover tool built collaboratively between departments can improve the quality and adherence of OR to PICU handover and improve patient safety. Simplification makes it adaptable and applicable in many different healthcare settings.

Designing and Validating an Evidence-Based, Shift-to-Shift Handover Bundle for Nurses and Physicians.

This article reports a study aimed at developing and validating an evidence-based, shift-to-shift handover bundle for nurses and physicians to be used at shift changes in intensive care and emergency units. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability can have unwanted consequences for hospitalized patients, particularly those at critical areas. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, standardized handover bundles for nurses and physicians are limited in the emergency and intensive care unit. As a result of this study, a shift-to-shift handover bundle was created, which was an evidence-based research design. This bundle is expected to be helpful for proper patient transfers between these critical areas, ensuring patient safety and efficient quality management.

Developing an Operating Room-to-Intensive Care Unit Patient Handover Checklist: A Combined Quantitative and Qualitative Research Design.

This article reports a study aimed at developing and validating an Operating Room-to-ICU Patient Handover checklist. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability can have unwanted consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, standardized handover bundles for nurses and physicians are limited in the intensive care unit. As a result of this study an Operating Room-to-ICU Patient Handover checklist was created, which was based on a quantitative and qualitative research design. This checklist is expected to be helpful for proper patient transfers between these critical areas, ensuring patient safety and efficient quality management.

Long-Term Sustainability and Adaptation of I-PASS Handovers.

Inadequate communication during transitions of care is a major health care quality and safety vulnerability. In 2013 Massachusetts General Hospital (MGH) embarked on a comprehensive training program using a standardized handover system (I-PASS) that had been shown to reduce adverse events by 30% even when not completely executed on each patient. In this cross-sectional study, the authors sought to characterize handover practices six years later. Using a standardized interview tool, the researchers evaluated handovers between responding clinicians in 10 departments and then validated these findings through direct observations, allowing for flexibility and customization in the I-PASS elements. The study qualitatively compared I-PASS element use in verbal handovers to MGH early postintervention data, as well as verbal and written handovers with the I-PASS Study Group's postintervention results. The authors observed 156 verbal and reviewed 182 written patient handovers. Ninety percent of departments adhered at least partially to the I-PASS system. Average handover duration ranged from 0.6 to 2.1 minutes per established patient. The service with best I-PASS adherence also consistently included the most information per unit of time. Acknowledging substantial differences in study technique, MGH adherence was, on average, comparable or better on all I-PASS elements in verbal handovers and on three of four elements of written handovers compared with the I-PASS Study Group's postintervention results. Although uptake has varied across services, six years after hospitalwide implementation of I-PASS, the majority of services are performing structured and sequenced handovers, most of which include some elements of the I-PASS system. Those services with the best I-PASS adherence conducted the most efficient handovers.

Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions

Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals’ individual workflow after surgery.Conclusion: A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care.What is Known:• Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary.• Checklists are assumed to facilitate cognitive load among providers in acute clinical environments.What is New:• A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time.• The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.

SINNHAFT—mnemonic for standardized handover in the central emergency department

ZusammenfassungIn der Regel existiert nur eine Möglichkeit für die Übergabe in der Medizin und somit für die Übertragung relevanter Behandlungs- und Patienteninformationen. Der Übergabe an der Nahtstelle zur zentralen Notaufnahme muss somit eine außerordentliche Bedeutung beigemessen werden. Auch aus juristischer Sicht, im Sinne der Übertragung der Verantwortlichkeit, schließt die Übergabe einerseits die präklinische Versorgung ab und gewährleistet andererseits die Weitergabe wichtiger Informationen, um eine bestmögliche klinische Versorgung zu gewährleisten. Aufbauend auf dem Konsensuspapier aus dem Jahr 2020, mit insgesamt 15 Empfehlungen zum strukturierten Übergabeprozess in der zentralen Notaufnahme (ZNA), wurde ein Delphi-Verfahren mit 52 Teilnehmern eingeleitet, welches sich an den Regularien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) orientiert. Im März 2023 konnten die Ergebnisse der zwei Abstimmungsrunden publiziert werden und bieten somit eine evidenzbasierte Grundlage zur Definition der festen Inhalte einer Merkhilfe. Unter Berücksichtigung aller Ergebnisse des Delphi-Verfahrens lässt sich eine Merkhilfe mit dem Akronym „SINNHAFT“ ableiten. Somit ist SINNHAFT 1.0 eine konkrete Merkhilfe, welche erstmalig in einem aufwendigen wissenschaftlichen Prozess Übergabeinhalte, unter Integration von CRM(Crew Ressource Management)-Aspekten, definiert und die Basis für eine Standardisierung der Übergabe an der Nahtstelle Rettungsdienst zur ZNA in Deutschland darstellt.

Shift handover quality in Saudi critical care units: determinants from nurses’ perspectives

BackgroundNurses’ effective handover communication is vital for patient safety and quality of care. Few studies have empirically tested how certain factors influence the quality of handover in the Saudi context.MethodsA descriptive correlational design was used with a convenience sample of all nurses (N = 201) working in Saudi hospital CCUs in 2022. Demographics and handover quality instruments were used to collect the necessary data in addition to two open-ended questions that asked about perceived barriers and facilitators to handover. The analysis was conducted using descriptive statistics and regression analysis.ResultsThe majority of nurses reported good-quality handover. The regression analysis showed that staffing, cognitive capacity, the focus of attention, relationships, and safety climate factors contributed positively to the variance of handover quality. In contrast, intrusions, distractions, anxiety, time stress, and acute and chronic fatigue factors negatively affected the prediction of handover quality (p < 0.05). Nurses added types of shifts and languages as barriers to handover while emphasizing training and the use of standardized tools for handover as facilitators.Conclusion and recommendationsNursing handover is a multidimensional phenomenon. By understanding the determinants that contribute to or hinder handover quality, it is possible to develop targeted interventions aimed at improving communication and the quality of shift handover in CCUs. The current study’s findings highlight the need for nurses to work in a more supportive environment, receive better training, and follow a standardized handover protocol. Additionally, nurse managers should pay more attention to nurses’ well-being to control or mitigate the effect of psychological precursors on the quality of nurses’ handover. Future research should investigate handover practices and outcomes on units that have both good and bad practice environments.

Paramedic to trauma team verbal handover optimization - a complex interaction.

Handover to the trauma team is crucial to trauma care. The emergency medical services (EMS) report must be concise, contain key details, and be time-limited. Effective handover is difficult, often occurring between unfamiliar teams, in chaotic environments, and without standardization. We aimed to evaluate handover formats in comparison to ad-lib communication during trauma handover. We conducted a single-blind randomized simulation trial evaluating 2 structured handover formats. Paramedics randomly assigned to ad-lib, ISOBAR (identify, situation, observations, background, agreed plan, and readback) or IMIST (identification, mechanism/medical complaint, injuries/ information about complaint, signs, treatments) handover formats underwent scenarios in an ambulance, then transfer to the trauma team. Assessment of handovers was completed by the trauma team and by experts using audiovisual recordings. Twenty-seven simulations were conducted, 9 for each handover format. Participant ratings of the usefulness of the IMIST and ISOBAR formats were 9/10 and 7.5/10, respectively (p = 0.097). Quality of the handover was deemed higher by team members when a statement of objective vital signs and a logical format was used. Handovers delivered with confidence, directed and summarized by a trauma team leader, before physical patient transfer, and without interruption were identified as having the highest quality. The type of format was not a significant contributor to handover; however, we identified a matrix of factors affecting the quality of trauma handover. Our study shows agreement by prehospital and hospital personnel that a standardized handover tool is preferred. A brief confirmation of physiologic stability, including vital signs, limiting distractions, and team summarization improves handover effectiveness.

Nursing Handover: Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital

Continuity in delivery of nursing care to patient in the critical care unit is of utmost importance. Although nurses have a variety of guidelines and formats to conduct the handover, gaps have been detected regarding the contents of the handover and its effects on the continuity of care in the critical care unit. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. The study adopted a phenomenological qualitative design. A sample of 9 critical care nurses participated in this study. The study found critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental nursing handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. The participants also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. The resultant implication for each group of stakeholders promotes the adoption and formulation of effective handover practices and consequently enhanced quality of patient care through transfer of adequate patient information and sense of self-accomplishment among nurses. Keywords: Nursing handover, experiences, perspectives, critical care unit

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

510 Improving Trauma &amp; Orthopaedic Handover During a Pandemic: Keeping Patients Safe - A Closed Loop QIP

AimLack of communication and incomplete handover leads to errors and patient harm. Staffing challenges caused by Covid-19 highlights the necessity for high-quality handover. Our aim was to assess the quality of T&O weekend ward handover and evaluate the implementation of a formal handover document to improve the process.MethodJunior doctors completed a survey to measure the efficacy and safety of current handover. A formalised written handover document in line with RCS Safe Handover recommendations was created and included in the doctors’ inductions. Evaluation was after 5 weeks with post-intervention questionnaires and new doctor rotation feedback.ResultsPrior to introduction of the handover document, 78% stated they were unable to formally handover. 77% experienced incomplete or unclear handover when working on the weekend. Lack of a standard handover process was deemed ineffective and unsafe.All respondents reported more efficient working with the new process. The perceived safety rating significantly increased from 2.33 out of 5 to 4.23 (p<0.0001). The new cohort of junior doctors rated the safety of handover to be 3.54, showing there is still scope for improvement in patient safety.ConclusionsThe use of standardized handover tools had a positive impact, improving the safety and quality of weekend handover. Workload was prioritized appropriately with improved transfer of information between teams. Covid-19 creates numerous challenges for safe clinical care. Working in unfamiliar environments and last-minute rota changes need to be mitigated by robust handover processes.

환자 안전을 위한 요양병원 인수인계 현황에 대한 조사연구

This study is related to 80% of communication errors among medical personnel among safety accidents in nursing hospitals in Korea, and 37% errors occur in the handover process of exchanging patient information between nurses. It is emphasized that there is a close relationship with With the aging society, the number of nursing hospitals is also increasing, so it was attempted to provide basic data to prepare a management strategy to improve the takeover by grasping the current status of the nursing hospital takeover. This study conducted a questionnaire survey on 102 nurses working in 4 nursing hospitals located in P city from September 30 to October 11, 2019. The collected data were analyzed using SPSS/WIN 21.0, and the reliability of the tool was measured by Cronbach's ɑ, and descriptive statistics were performed on the general characteristics of subjects and characteristics related to takeover, the degree of error experience, and the causes of errors. As for the takeover-related characteristics of the subjects of this study, 15 respondents (63.8%) answered that there is no written guideline or checklist for handover, and 'there is no written guideline or checklist on handover. There were 92 nurses (92.1%) who thought it was necessary, and as a result of the handover error experience, 'have ever been criticized or complained of from a patient or guardian due to a handover error' was 1.89±0.73. The highest score was 1.73±0.73 for 'Sometimes a shift worker said that he did not take over even though he was given a handover', followed by 'Sometimes I misunderstood the details of the handover' and 'I called to confirm because the handover was incorrect. 'Has ever been' with 1.72±0.87. As for the cause of errors in the takeover of nurses, it was found that nurses considered ‘xcessive workload’ to be the most common cause of errors during takeover with a score of 2.69±0.67. Next, 'there is no standardized handover guidelines (contents, methods)' with 2.64±0.80 and 'personal tendencies work during takeover' with 2.61±0.74, indicating human error in relation to errors occurring in the handover process. It was found that the possibility of The subjects of this study mentioned excessive workload, lack of guidelines, and human error as causes of takeover errors during takeover. Therefore, since reducing handover errors is an important factor for patient safety, we believe that standardized guidelines are needed as a method to reduce the causes of handover errors.

Lost in relocation: longitudinal surveys evaluating the effectiveness of ICU to ward handover after the introduction of an electronic patient record

ABSTRACT Background Poor communication and lack of standardized handover practices contribute to adverse events. Intensive care organizations recommend standardized, structured written and verbal handover. Objectives Investigate the effectiveness of, and barriers to, Intensive Care Unit (ICU) patient handover at ward transfer. Screen for patient safety incidents related to poor handover and improve practice where deficiencies are identified. Methods A survey of ward doctors about specific ICU to ward transfers and online surveys ascertaining opinions of handover processes were sent to ward-based and ICU doctors at a large, adult, university affiliated, Australian quaternary hospital. We delivered departmental education and created then publicized a new electronic ICU transfer summary. The summary included a mandatory tick-box to confirm verbal handover completion. Surveys re-assessing practice were then performed. Results Forty ward-based doctors were surveyed about specific transfers, with 7 (18%) instances of issues related to handover identified. Eighty-seven ward doctors completed the pre-interventions survey; 48 (55%) were aware of the existing written transfer summary. Post-interventions, 47 (75%) of 63 ward doctor responders were aware of it (p < 0.05). Pre-interventions, 14 (16%) ward doctors rated ICU handovers as excellent or good, rising to 21 (34%) post-interventions (p < 0.05). Thirty-nine ICU doctors completed the pre-interventions survey; 5 (13%) rated ICU to ward handover as excellent or good, rising to 9 (35%) when re-surveyed (p = 0.097). Conclusions The perceived quality of ICU to ward handover improved after our interventions. However, ICU doctors continue to transfer patients without verbally handing over, with contacting the ward team representing a significant handover barrier.

Experiences of handovers between shifts among nurses in small and medium-sized hospitals: A focus-group study.

Nursing handovers represent an important and complex form of communication in healthcare organizations that involve the exchange of patient-related information between nurses. This qualitative descriptive study aimed to identify the intershift handover experiences among nurses working in small and medium-sized hospitals. Focus-group interviews were conducted with 30 nurses who directly participated in patient care in such hospitals in South Korea. The reporting of the study findings adhered to the Consolidated Criteria for Reporting Qualitative Research checklist. The data were analyzed using content analysis. Under the main theme of "baton touch in a relay," 6 categories, 17 subcategories, and 45 codes (concepts) were derived. The six categories were "procedural rituals for shifts," "nonstandardized handover training," "inconsistent handover style," "stress due to handovers," "coping strategies for handovers," and "interruptions of handovers." Nurses in small and medium-sized hospitals strive to improve the quality of handovers by preparing individual-level coping strategies under difficult conditions. This indicates that standardized handover education strategies need to be developed for nurses that are suitable for the personnel systems of small and medium-sized hospitals.

Effect of a Handover Tool on Communication in the Labor and Delivery Unit During Hand-Off Reports

This project is aimed at identifying the effect of implementing a standardized handover tool in the labor and delivery unit. Ineffective communication can lead to medical errors, compromising the safety and the quality of care in labor and delivery units. Situational awareness is required during the handover process to ensure that continuity of patient care is achieved by giving clear and concise patient information. This project supports the mission of the Association of Women’s Health, Obstetric and Neonatal Nurses by empowering nurses to make practice changes that will improve the care of women, newborns, and their families.

Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults

Intraoperative handovers of anesthesia care are common. Handovers might improve care by reducing physician fatigue, but there is also an inherent risk of losing critical information. Large observational analyses report associations between handover of anesthesia care and adverse events, including higher mortality. To determine the effect of handovers of anesthesia care on postoperative morbidity and mortality. This was a parallel-group, randomized clinical trial conducted in 12 German centers with patients enrolled between June 2019 and June 2021 (final follow-up, July 31, 2021). Eligible participants had an American Society of Anesthesiologists physical status 3 or 4 and were scheduled for major inpatient surgery expected to last at least 2 hours. A total of 1817 participants were randomized to receive either a complete handover to receive anesthesia care by another clinician (n = 908) or no handover of anesthesia care (n = 909). None of the participating institutions used a standardized handover protocol. The primary outcome was a 30-day composite of all-cause mortality, hospital readmission, or serious postoperative complications. There were 19 secondary outcomes, including the components of the primary composite, along with intensive care unit and hospital lengths of stay. Among 1817 randomized patients, 1772 (98%; mean age, 66 [SD, 12] years; 997 men [56%]; and 1717 [97%] with an American Society of Anesthesiologists physical status of 3) completed the trial. The median total duration of anesthesia was 267 minutes (IQR, 206-351 minutes), and the median time from start of anesthesia to first handover was 144 minutes in the handover group (IQR, 105-213 minutes). The composite primary outcome occurred in 268 of 891 patients (30%) in the handover group and in 284 of 881 (33%) in the no handover group (absolute risk difference [RD], -2.5%; 95% CI, -6.8% to 1.9%; odds ratio [OR], 0.89; 95% CI, 0.72 to 1.10; P = .27). Nineteen of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group experienced all-cause 30-day mortality (absolute RD, -1.3%; 95% CI, -2.8% to 0.2%; OR, 0.61; 95% CI, 0.34 to 1.10; P = .11); 115 of 888 (13%) vs 136 of 872 (16%) were readmitted to the hospital (absolute RD, -2.7%; 95% CI, -5.9% to 0.6%; OR, 0.80; 95% CI, 0.61 to 1.05; P = .12); and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious postoperative complications (absolute RD, 0.3%; 95% CI, -3.6% to 4.1%; odds ratio, 1.02; 95% CI, 0.81 to 1.28; P = .91). None of the 19 prespecified secondary end points differed significantly. Among adults undergoing extended surgical procedures, there was no significant difference between the patients randomized to receive handover of anesthesia care from one clinician to another, compared with the no handover group, in the composite primary outcome of mortality, readmission, or serious postoperative complications within 30 days. ClinicalTrials.gov Identifier: NCT04016454.

AB178. SOH22ABS218. Standardization and implementation of virtual surgical handover

Background: The fundamental aim of any handover is to achieve the efficient transfer of high-quality clinical information at times of transition of responsibility for patients. Studies have shown that poor handover can be associated with adverse patient events. Due to a change in work patterns, namely shift work, the need for clear, standardized, and safe handover is vital. We aimed to assess adaptation to a new virtual handover format, consisting of verbal and written handover presented daily by the post call registrar to the general surgery department.

Optimizing handover in patients with stroke symptoms utilizing an organized protocol between emergency department providers and emergency medical personnel

IntroductionStroke care is time sensitive. Providers in the emergency department (ED) depend on advanced notification from emergency medical services (EMS) transporting patients with stroke signs and symptoms. Barriers to EMS-ED information transfer can delay patient arrival preparation that may impact decisions, diagnosis, and time-sensitive transfer to next site of care. Information gaps or loss of information in the chain of care has been noted to contribute to possible safety threats for patients with stroke symptoms. MethodsThe aim of this project was to explore the feasibility of improving EMS-ED handover of patients with suspected stroke using a two-tiered checklist ranked in order of importance and a “time-out” upon EMS arrival to help standardize report, bridge the information gap, and promote earlier stroke management decisions. Paramedics from two local EMS agencies participated. Transmission and recorded report were measured before and after implementation followed by a satisfaction survey. Analysis also included a comparison group (control) of non-participating Fire Departments. ResultsOne hundred and sixty-eight potential stroke patients were transported to the ED during the 16-month intervention time frame. The pre and post intervention analysis of reported stroke symptoms showed statistically significant improvement in multiple checklist reporting areas. Noteworthy changes included improvement in reporting last time normal, current antiplatelet/anticoagulant, neurological deficits, baseline mental and functional status, medical history, code status, recent surgical history and family enroute. A post-survey demonstrated overall positive EMS-ED response to the new handover process. ConclusionThe feasibility of an EMS-ED standardized handover using a hierarchical (ranked in order of importance), two-tiered checklist and time-out process can effectively bridge the gap of communication between EMS and emergency providers to help promote timely hyperacute stroke care.

EP.TU.45Organising The Huddle: An Audit Loop of the Surgical Handover

Abstract Aim Structured patient handover is a critical element for the patient safety. There are several guidelines including the ones from NICE and Royal College of surgeons emphasizing its importance in today’s practice. It entails appropriate coordination and communication among health-care providers to ensure safety of the patients and avoid adverse incidences. This audit was performed to assess and improve the current Surgical Handover Meeting in line with the Handover Guidelines from the Royal College of Surgeons of England (Rcseng.ac.uk, 2007). Method A questionnaire was circulated among the surgical doctors involved in the handover meetings. Outcomes were compared with the NICE and RCS guidelines. Recommended changes were implemented after training the staff which was followed by second cycle of audit. Results During the first cycle of audit, 80% of the junior surgical doctors contributed towards the study who agreed there was no standard format of handover, information was incomplete and there was lack of privacy. A standardized handover sheet was introduced which included accurate and concise information about patients with their management plans. There was noticeable improvement in staff satisfaction in second cycle but use of quiet room and nurse’s attendance remained poor. Conclusion Safe handover reflects quality of patient care. Despite achieving remarkable improvement after first audit we still lag behind the recommended practice. With all the support and coordination; further projects, meetings and presentations are required to achieve the outstanding standards.

The conservative emergency room - care of acutely critically ill non-trauma patients

Treatment of critically ill non-trauma patients is challenging, due to the broad spectrum of underlying diseases in this clinical setting. It has been shown that outcome in these patients is poor due to high age, comorbidities and severeness of acute disease. In most cases it is crucial to establish diagnosis and start specific treatment immediately to improve patients' outcome. In contrast to the management of severely injured patients, general guidelines for the initial diagnostic and therapeutic approaches in these patients have been lacking until now. As a consequence, little is known about both: patients' characteristics and outcome. This article provides an overview of the current information available on this group of patients.All critically ill patients should first be managed in the resuscitation room, as it is necessary to provide the optimal infrastructure, including material and personal resources, to maintain high quality care. For non-trauma patients, indication can be defined using the ABCDE approach. Expertise in emergency ultrasound as a key diagnostic tool, profound knowledge of intensive care treatment and of diagnostic and therapeutic approaches according to current specific guidelines are required. These requirements can be implemented by assembling nursery and medical staff trained in emergency care, supported by accredited continued professional development and regular simulation trainings.The best transition from preclinical to in-hospital care is achieved through detailed preparation and the use of standardized handover tools. Subsequent patient management can be organized using the primary and secondary survey. These aim to detect and treat life threatening pathologies first and, within a second step, to expand the diagnosis and therapy according to the individual case. Special focus should be put on communication, using crew resource management training, and on the provision on an open and constructive approach to making mistakes.