Improving the quality of handover in a liaison psychiatry team

"Without guidelines handover between shifts is of a poor quality, and often lacks key information to allow colleagues to identify patients and prioritise need. Education of those performing these handovers did not produce any benefits, either immediately following its delivery or in longer term follow up. The implementation of a template to aid clinicians in recording this data did produce improvements and received positive feedback from doctors."

Improving the quality of handover in a liaison psychiatry team
J Brook, M Amaro Calcia
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u206492.w3442

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Half-life of a printed handoff document

"In this report, we identify a very high potential for inaccurate information in printed handoff documents. If a handoff document is printed at the start of a night shift, it is reasonable to assume that within 6 h the document will contain inaccuracies on half of the patients. The field most likely to contain inaccuracies is the medication lists, followed by code status."

Half-life of a printed handoff document

G Rosenbluth, R Jacolbia, D Milev, AD Auerbach

BMJ Quality and Safety, 2016;25:324-328 doi:10.1136/bmjqs-2015-004585

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Anticipatory management communication in end-of-shift medicine and nursing handoffs

"The different frequencies for types of AMC likely reflect differences in how residents and nurses work and disparate professional cultures. But, verbal communication in both groups included important information unlikely to be captured in written handoff tools or the electronic medical record, underscoring the importance of direct communication to ensure safe handoffs."

“Mr Smith's been our problem child today…”: anticipatory management communication (AMC) in VA end-of-shift medicine and nursing handoffs
AA Bergman, ME Flanagan, PR Ebright, CM O'Brien, RM Franke
BMJ Quality and Safety 2016;25:84-91 doi:10.1136/bmjqs-2014-003694

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A simple prioritisation system to improve the electronic handover

"Overall the introduction of an uncomplicated traffic light system provided an effective addition to the electronic handover structure aimed to allow patient prioritisation and improved efficiency during weekend hours."

A simple prioritisation system to improve the electronic handover
L Ah-kye, M Moore
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205385.w4127

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Improving the Quality of Weekend Medical Handover at a London Teaching Hospital

"A new weekend handover pro forma modelled on RCP guidance can improve the quality of information provided to the weekend team. This can help the on-call team to manage the weekend more effectively and safely. A Friday WR [ward round] sheet can also improve the availability of thorough patient summaries in the notes in the event that someone needs to be reviewed unexpectedly over the weekend."

"Chase CRP", "Review patient": Improving the Quality of Weekend Medical Handover at a London Teaching Hospital
A Saifuddin, L Magee, R Barrett
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u201656.w1919

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Intensive care discharges: improving the quality of clinical handover

"This project demonstrated how modifying system factors, such as a standardised template, could effectively modify individuals’ practices. Simple changes to the design of an intensive care discharge summary have been shown to greatly improve the quality of handover information, with the aim of improved continuity and quality of care."

Intensive care discharges: improving the quality of clinical handover through changes to discharge documentation
W Hall, P Keane, S Wang, F Debell, A Allana, P Karia
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209711.w4036

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Using a simple handover to improve the timing of gentamicin levels

"Prior to our intervention, the timing of gentamicin levels was poorly performed, with 42.2% of levels taken late and two episodes of missed doses were reported."

Using a simple handover to improve the timing of gentamicin levels
A Williamson, A Bradley, K Khan
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207727.w3081

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Improving the quality of handover

"This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department."

Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting
H Walton, W Munro
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206069.w2989

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Improving handover from intensive care to ward medical teams with simple changes to paperwork

"This quality improvement project serves to demonstrate that carefully targeted, simple changes to practice in identified critical areas can produce dramatic as well as legally and ethically required results in a very short space of time."

Improving handover from intensive care to ward medical teams with simple changes to paperwork
J Messing
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206467.w2913

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Improving the handover and care of acute urological admissions

"The 3 simple changes made to our practice both inwardly and outwardly have made great improvements to the care of our patients. Our handovers are more successful and the middle grade urologists are involved in the care of their patients at a much earlier stage much more commonly."

Improving the handover and care of acute urological admissions
E Bass, S Patel
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204762.w3422

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Patient handover in orthopaedics, improving safety using Information Technology

"Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover."

Patient handover in orthopaedics, improving safety using Information Technology
T Pearkes
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207329.w2939

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Introduction of a new electronic medical weekend handover

"The weekend medical handover system among junior doctors at Tunbridge Wells Hospital in Pembury, UK was cumbersome, inadequate and poor, restricting the ability to provide good patient care. 78.6% of doctors felt that the introduction of an electronic weekend handover system would address the issues in order to improve communication between the medical teams and thus improve patient care." 

Introduction of a new electronic medical weekend handover at Tunbridge Wells Hospital
R Vithlani
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204755.w2342

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Traffic lights: putting a stop to unsafe patient transfers

"we feel that our tool could be developed for use for all intra-hospital transfers at Watford General Hospital, and could be more widely used in acute hospital trusts under similar pressures to increase patient flow, reducing the clinical risks associated with patient transfer."

Traffic lights: putting a stop to unsafe patient transfers
A Parbhoo, J Batte
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204799.w2079

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Ward round documentation in a major trauma centre: can we improve patient safety?

"We show that our new system of note keeping for use during ward rounds in a major trauma centre improves both the quality and consistency of ward round entries. It consolidates each member of the team’s knowledge about each patient, and contributes to effective handover. "

Ward round documentation in a major trauma centre: can we improve patient safety?
G Green, A Aframian, J Bernard
BMJ Quality Improvement Reports 2014;3: doi:10.1136/bmjquality.u206189.w2537

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Improving phlebotomy handover to doctors

"Implementation of a hospital-standardised phlebotomy handover folder dramatically improved the communication and handover between phlebotomists and doctors allowing for medical teams to take prompt action on unbled patients. This intervention will help improve patient safety, reduce delays in management/discharge and reduce the number of jobs handed over to evening on-call teams."

Improving phlebotomy handover to doctors: a quality improvement project
G Shouls, Z Jarrar, J Wickenden
BMJ Quality Improvement Reports 2014;3: doi:10.1136/bmjquality.u204813.w2033

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

"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."

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care
C Yusuf Akhunbay-Fudge, I Buss, A Ward, C Snead, M Cole, A Coulter
BMJ Quality Improvement Reports 2014;3

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Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

"There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge."

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping
G Hesselink et al.
BMC Health Services Research 2014, 14:389

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Barriers to implementation of a redesign of information transfer and feedback in acute care

"Accurate communication is an important feature of seamless care and enhances patient safety. Information transfer and patient handovers are noted to be potentially hazardous areas for error in emergency care."

Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study
JE van Leijen-Zeelenberg, AJA van Raak, IGP Duimel-Peeters, MEAL Kroese, PRG Brink, D Ruwaard, HJM Vrijhoef
BMC Health Services Research, 2014, 14: 149

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