Patient Safety & Clinical Handover Kiaran Flanagan, Consultant Acute Physician Acute Medicine Team

Acute Medicine

Acute Medicine Busy Lots of sick people Lots of doctors Wide spectrum of practice You have to keep you eye on the ball... HIGH RISK AREA OF CLINICAL PRACTICE

What is our minimum standard? “The very first requirement in a hospital is it that it should do the sick no harm” Notes on Hospitals, 1863

What is patient safety? “The avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare”

Or ... Actions undertaken by individuals and organizations to protect health care recipients from being harmed by the effects of health care services

No needless pain or suffering No unwanted waits No helplessness Our Aim No needless deaths No needless pain or suffering No unwanted waits No helplessness No waste For anyone....

The scale of the problem 1 in 10 patients suffer adverse event 850,000 adverse events in hospitals/ year 8% result in death 6% result in permanent disability Costs £400 million/ year in compensation

Factors Affecting Patient Safety Task Individual Team Working Conditions Organisational Governmental & Regulatory

A couple of little stories...

Fell over on the way to the shed Collapsed with LOC on the way to the shed Haemodynamically compromised Malaena apparent Resuscitated “HIGH RISK GI BLEED” Stabilised until morning Not picked up as sick on WR Could go home Discharged stopped OGD reorganised In OGD went to toilet collapsed with massive bleed and died

Fell over on the way to the bathroom Tripped over cat Chest pain ? rib fracture Paramedics kept at home 1 week later ED with chest pain ?ACS Seen by consultant 16 hours later Fractured ribs, abn CXR and abdominal pain CT 5 hours later Chest drain Died after 12 hours

Fell over on the way to the kitchen Simple fall, low back pain ED, not steady - admit X ray thoracic spine NAD 48 hours later opoids for pain Transferred under AMT Picked up next morning (Fri) “Not right”, tests ordered Not seen over weekend Cardiac arrest (Mon am) on ward round

Its all about cheese...

Never Events

Human Factors

What is Clinical Handover? 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 permanent basis National Patient Safety Agency, 2005

Why Clinical Handover? Continuity of sufficient and relevant information(and appropriate action) to suitably experienced clinicians is vital to the safety of our patients

Responsibility & Accountability “Individuals and organisations have a shared responsibility to ensure that safe continuity of information and responsibility takes place” “Information provided during handovers influences the delivery of care for the whole shift”

What it’s supposed to achieve Sufficient and relevant information should be exchanged Clinically unstable patients made known to senior and covering clinicians Unstable patients receive review Juniors adequately briefed of concerns from personnel and previous shifts At risk areas/ situations identified

Getting practical Morning Clinical Handover 08:30 CDU Evening Clinical Handover 17:00 ED Seminar Room H@N Clinical Handover 20:30 Control Room

Even with the best planning in the world...