Improving Surgical Handover: Has using a word-processed document improved the quality of general surgical handover? Completed audit cycle Undertaken at Conquest Hospital, East Sussex Healthcare Trust Sara Khoyratty, CT1

“Your team were on-call yesterday, here’s your list….”

Standards

RCS Safe Handover Guidance

Audit questions Were we documenting and, therefore, reliably handing over this minimum amount of data with paper handover sheets? What proportion of handover sheets were retained by the department as evidence of productivity?

Method AUDIT: 4 months of paper handover sheets – Organised into months April-July – Data collected Per patient Per list Per month RE-AUDIT: 4 months of word processed handover sheets – Organised into months September - December – Data collected and analysed as above

Audit Conclusion Keeping a copy of handover lists was very low, ranging from 14% to 65% – Is there a better way of storing this information? Basic information should be 100% Clinical detail needs to be improved – only % of patients have a plan or pending investigations handed over – More space – Educate doctors

Changes implemented Highlighted problems to FY1s and SHOs in Surgery and Orthopaedics Explained new system available on ward computers Encouraged to be as thorough as possible Easy access to document templates Explained where to save documents in organised system Encouraged to feedback suggestions or problems

Changes implemented

Results: patient load MonthPatients per month April 75 May 111 June 76 July 57 MonthPatients per month Sept 118 Oct 137 Nov 137 Dec 126 Paper list:Word processed list :

Results: number of lists retained Month No. of lists retained (%age retention) April42% May65% June14% July26% Month No. of lists retained (%age retention) Sept 87% Oct 77% Nov 87% Dec 94% Paper list:Word processed list:

Results: named on call consultant Month Recorded on-call consultant April42% May65% June14% July26% Month Recorded on-call consultant Sept 63% Oct 65% Nov 80% Dec 84% Paper list:Word processed list:

Results: patient data set completeness Month Average completeness of patient data set (range) April 68.1% (50.0% – 77.8%) May 68.3% (50.5% %) June 74.9% (65.6% %) July 68.5% (54.6% %) Month Average completeness of patient data set (range) Sept 75.2% (52.8% %) Oct 80.5% (63.2% %) Nov 85.0% (72.2% %) Dec 78.0% (69.4% %) Paper list:Word processed list:

Results: basic information Information Range of completeness: basic information Name 99% - 100% Patient number 82% - 100% DoB/Age 84% - 92% Location89% - 98% Information Range of completeness: basic information Name 100% Patient number 93% - 99% DoB/Age73% - 88% Location 97% - 100% Paper list:Word processed list:

Results: clinical information Information Average completeness of clinical patient data Diagnosis88% - 96% Results51% - 64% Pending39% - 61% Plan50% - 64% Stability2% - 9% Paper list:Word processed list: Information Average completeness of clinical patient data Diagnosis 97% - 100% Results 62% - 88% Pending 69% - 85% Plan 78% - 96% Stability 6% - 15%

Comparison What did we improve? Number of lists saved Overall amount of data recorded per patient & per list Name, location and X numbers recorded Diagnosis, results, pending and plan recorded Overall satisfaction and non-measured improvements, e.g. name of SpR/FY1 on call

Comparison What did we fail to significantly improve or worsen? Stability of the patients Recording the named consultant on-call

Critique Statistical comparison difficult as percentages skewed by disproportionate data Verbal handover just as important Some data was less consistently handed over

Further changes Microsoft Access database to ensure minimum dataset entry and accurate records. Have a tick-box system to denote stability, e.g.: Stability ✓ Stable Urgent Critical

Further audit Implement these changes and re-audit Audit verbal handover for e.g. 1 week: RCS guidance document Data collection for 1 year

Thank you!