1. Improving Medical Handover HCH Journal Club Thursday 13 th October 2011 M. Wajid Raza

2. Overview Problems during handover Handover methods Evidence-based changes Conclusions and discussion

3. Problems During Handover

4. Handover Methods No handover Verbal, face-to-face Freeform paper Template-based paper Electronic handover Multidisciplinary handover A combination of the above

5. Evidence for verbal handover Evidence for paper-based handover Evidence for electronic handover The Evidence

6. Verbal Handover

7. ISBAR

8. http://www.pssjournal.com/content/2/1/24

9. Table 1 Data handed over by data type. Handwritten sheets (n = 49)Handover proforma (n = 55)Significance Handed overMissingHanded overMissing Label3514532p < 0.01 Name481550N.S. Date of Birth445541N.S (p = 0.13) Unit number472550N.S (p = 0.28) Side of injury2821541p < 0.01 Injury445550N.S (p = 0.13) Tasks performed or outstanding 1534550p < 0.01 Relevant blood results (pre n = 32; post n = 29) 626623N.S. (p = 0.84) Total data handed over per patient 72.6% (S.D. 16.0%)93.2% (S.D. 9.6%)p < 0.01 http://www.pssjournal.com/content/2/1/24

10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964745/

12. Clin Risk May 1, 2011 17: 92-96 The study compared paper-based and electronic-based medical handover with respect to quality of information transfer during hospital out-of-hours shifts. The participants were 1645 hospital patients transferred from the day team to the out-of-hours team over four months in 2006. Quality of information transfer was determined by clinical data handed over within pre-set fields, and caseload burden by the frequency of tasks required at handover. Handover information fields comprised patient’s demographics and location, primary diagnosis, current problem, plan of action and primary care team details. Electronic handover achieved a significantly higher number of completed fields than paper-based handover. Blood collection, checking blood and X-ray results, and adjusting fluid balance and intravenous cannulation account for most of the workload during the nightshift. Electronic handover provides better continuity of care than paper-based handover, and redistribution of tasks during working hours would benefit night staff.

13. Conclusion & Recommendations Training helps improve handover Proformas are recommended for paper handover Electronic handover seems to be very efficient but may have hidden pitfalls Top-down handover systems design needed for good handover

14. References http://www.bma.org.uk/images/safehandover_tc m41-20983.pdf http://www.bma.org.uk/images/safehandover_tc m41-20983.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1 964745/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1 964745/ http://www.medscape.com/viewarticle/743857 http://jhi.sagepub.com/content/15/3/191.abstra ct http://jhi.sagepub.com/content/15/3/191.abstra ct http://www.pssjournal.com/content/2/1/24 http://careers.bmj.com/careers/advice/view- article.html?id=20000883 http://careers.bmj.com/careers/advice/view- article.html?id=20000883