Andrew Batchelder Specialty Registrar in Surgery & NIHR Academic Clinical Fellow in Medical Education University Hospitals of Leicester NHS Trust Using IT to improve communication at the time of handover

Definition “The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or a permanent basis” NPSA

Why is handover important? “You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients’ medical care. These arrangements should include effective hand-over procedures, involving clear communication with healthcare colleagues.” GMC

Why is handover important?  Deficiencies of handover lead to:  inaccurate clinical assessment and diagnosis  delays in diagnosis  delays in test ordering  medication errors  inconsistent or incorrect results translation  duplication of results  increased length of stay  increased in-hospital complications  decreased patient satisfaction

Why is handover important?  Deficiencies in handover is a major contributor to deaths  NCEPOD report – 13.5% of deaths within 4 days  70% of medical errors have been attributed to poor communication  Deficiencies in clinical handover identified as the root cause or significant contributor in 23% of patient safety incidents (UHL audit 2011/2012)

Existing UHL Handovers  Hand written  Portable  No IT needed  Easily passed between teams  Time consuming to create  Quickly out of date  Risk of transcription errors  No central record  Easily lost (confidentiality)

Existing UHL Handovers  Word document  Printouts portable  IT required  Time consuming to create  Out of date unless updated via PC  Risk of transcription errors  No central record  Printouts easily lost (confidentiality)

The Solution: Mobile e-handover  Bespoke software solution  Patient lists generated from hospital PAS system  Patient information populates a database  Diagnosis, early warning score, outstanding tasks, etc. entered in real time via mobile devices  Facilitates task allocation and generation of automatic alerts when patients deteriorate  Reliable safe paperless transfer of information between medical and nursing staff

Adherence to RCP guidelines

Continuity of information

Benefits  Real time patient information to all team members  Easily configurable tool  Automatic task allocation (e.g. deteriorating EWS)  Protects patient confidentiality  Audit traceable  Potential to impact upon patient outcomes  Reduced SUIs  Improved patient flow  Reduced length of stay

Benefits  Releasing time for direct clinical contact  Junior doctors on the surgical unit spend 60 minutes less per day amending patient lists  Avoids ‘missed’ patients  Avoids duplication of tasks  Improved ‘user’ satisfaction (71% vs 57%)

Summary  Sharing clinical information in real time  Standardised handover  Increased accountability  Improved patient safety

Any questions?