Clinical Handover Presenter: Ned Douglas Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Clinical Handover Presenter: Ned Douglas Health Service: Melbourne Health 1

KEY PROBLEM Findings from the “Hospital at Night” project indicate that shift to shift clinical handover between junior medical staff (JMS) at Melbourne Health (MH) occurred in an inconsistent manner and did not meet best practice guidelines. Shift to shift handovers between JMS were only 52% compliant with Victorian Quality Council (VQC) criteria. This had the potential to negatively impact upon patient safety and continuity of care. 2

AIM OF THIS INNOVATION To improve and standardise shift to shift handovers between JMS for all general and specialist medical and surgical units, emergency department (ED) and intensive care unit (ICU) at RMH City Campus and Royal Park Campus.

BASELINE DATA 2010 Root Causes What does this Mean? No Melbourne Health Handover Guidelines Lack of standardised handover content, process and documentation across Melbourne Health: No minimum standards regarding content No specified time or place for handover No handover template for documentation purposes Competing Commitments Lack of protected handover time potentially resulting in lack of, or ineffective handover. JMS perception that evening handover time is at the end of the rostered shift (usually 5pm) Poor utilisation of cross-over periods. Can result in a lack of handover occurring at all. Much of handover occurring after rostered handover time. No Cross-over period because of rostering Lack of paid handover time, potentially resulting in lack of or poor handover. Decrease in JMS after Hours Handover required to multiple units resulting in less time available for handover per unit, potentially resulting in lack of, or ineffective handover

KEY CHANGES IMPLEMENTED Focused on Afternoon Handover in Specialty Medicine, the worst performing time for the worst performing units. Protected Handover time 1630-1700 Internal, Melbourne Health, handover guidelines were developed Handover education was given to all parties involved in handover Standardised documentation in the form of an electronic handover tool was provided Designated location: ward in specific location Standardise content (ISBAR) was required Standardised process was agreed upon by units involved and followed

KEY CHANGES IMPLEMENTED

Compliance to MH Handover Guidelines for DOCUMENTATION was 98% OUTCOMES SO FAR Pilot – 2011 Medical After Hours 2 Compliance to MH Handover Guidelines for DOCUMENTATION was 98% Handover Forms Documentation template (handwritten) given to each cover doctor. Despite compliance with documentation template there was no process to keep this information Therefore, there was still low accountability for information handed over – an electronic handover tool has been developed as a solution

Comparison of change of Adherence (%) to VQC Criteria OUTCOMES SO FAR Improvement - 2012 All units Comparison of change of Adherence (%) to VQC Criteria Measure Control Change Morning 54% 62.5% + 8.5% Afternoon 39% 60.3% + 21.3% Night 58% 70.3% + 12.3% Specialty medical units increased from 23% to 62.5% (VQC Criteria) following improvement.

LESSONS LEARNT Support from senior clinicians is vital Clarity around expectations on a very specific process level helped drive improvement Where existing processes were adapted, the best compliance was seen