Improving the Medical and Surgical Out-of-Hours Handover at a Hospital in Regional New South Wales, Australia

Abstract

Effective handover between shifts is widely accepted as essential for continuity of care and patient safety. Problems with out-of-hours handover were identified at our hospital, having come to light following attendance at handover meetings by the authors. Consultation of junior doctors was performed to identify issues with the out-of-hours handover and a baseline audit was conducted to objectively assess handover practice. Local guidelines were used to create a handover tool, which was subsequently implemented and assessed via multiple PDSA (plan, do, study, and act) cycles. In addition, registrar education was undertaken. Concurrently, meetings with senior clinicians and managers were held to address wider issues including venue, intensive care registrar attendance, emergency call procedures, and implementation of an electronic handover tool. Junior doctor consultation and baseline audit identified failings in handover. Following our intervention, improvements were demonstrated in the handover of patient information, including diagnosis (50% increase), investigations (76% increase), and plan (33% increase). Doctor attendance and punctuality also improved, along with a more punctual start time and reduced handover duration of five minutes on average. Bringing structure and leadership to an informal and inconsistent handover system using simple and well-defined methods can improve the quality and consistency of handover. The sustainability of the intervention was demonstrated with continued improvements seen in a subsequent cycle.