Quality improvement of doctors' shift-change handover in neuro-critical care
Postgraduate Medical Centre, The Clinical School, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK. Quality and Safety in Health Care
(Impact Factor: 2.16).
12/2010; 19(6):e62. DOI: 10.1136/qshc.2008.028977
Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit.
To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit.
A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed.
The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time.
Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients.
Available from: deepblue.lib.umich.edu
Available from: eprints.utas.edu.au
Available from: Brian Hilligoss
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ABSTRACT: This document reviews the full collection of literature on hospital handoffs and is referenced by shorter publications. Researchers may see abstracts at http://www.connotea.org/user/signout . Access to the full text of the articles may be requested by contacting the authors. Background: In hospitals, handoffs are episodes in which control of, or responsibility for, a patient passes from one health professional to another, and in which important information about the patient is also exchanged. In view of the growing interest in improving handoff processes, and the need for guidance in arriving at standardized handoff procedures, a review of the research on handoffs is provided. Methods: The authors have attempted to identify all research treatments of hospital handoffs involving medical personnel published in English through July 2008. Results: Findings from the literature are organized into six themes: 1) The definition of 'handoff'; 2) The functions of handoffs; 3) The challenges and difficulties of handing off; 4) The costs and benefits of standardization; 5) Possible protocols for standardizing of handoffs; and 6) Questions needing answers, and methods of research. Conclusions: The large body of relevant literature shows handoff to be highly sensitive to variations in context, to be an activity that is essential for multiple important functions within a hospital that range far beyond patient safety, and to be subject to difficult tensions that necessarily attend efforts to standardize action within a highly differentiated hospital setting. In addition, there is little empirical evidence regarding the magnitude of the impact of handoff on patient safety and service quality, making the potential gains and complications from standardization uncertain. Robert Wood Johnson Foundation http://deepblue.lib.umich.edu/bitstream/2027.42/61498/1/Handoffs_in_Hospitals_Literature_Review_081014.pdf
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