1. D Monnery, R Ellis, S Hammersley Leighton Hospital, Crewe

2. Outline a quality improvement study examining the benefit of handover training combined with an electronic handover program on out of hours patient outcomes and staff satisfaction

3.  Poor handover has been demonstrated to contribute to serious untoward incidents 1,2, patient mortality 3 and leads to greater staff and patient dissatisfaction as well as increased healthcare cost 4  Handover training has been highlighted as a key area for development by various healthcare organisations in order to address these risks 1,3,5  Despite encouragement to introduce handover training widely, there is a lack of evidence in this area as to what educational tools are most effective in creating transferrable handover skills among trainees 6

4.  At Leighton Hospital we introduced handover training to postgraduate trainees, and assessed the efficacy of this in combination with electronic handover, in improving patient outcomes and staff satisfaction  Measurement outcomes included: ◦ Staff satisfaction (using validated tools SAQ and TSCI 7 ) ◦ Out of hours mortality ◦ Out of hours discharges ◦ Length of stay ◦ Jobs completed out of hours ◦ Critical incidents

5.  Handover training was incorporated into the trust induction for junior doctors  Training consisted of: ◦ 1 hour and 15 minute lecture ◦ Videos of handover and interactive discussion of these ◦ Evidence based methods: SBAR and Think FIRST ◦ 1 and a half hour small group simulation training.  Trainees feedback showed statistically significant improvements in trainees self-rated confidence in time management, task management and handover

8.  Baseline data on patient outcomes was examined retrospectively for three months prior to training  Baseline staff satisfaction data was also analysed using validated tools  Further data was then collected prospectively for 3 months post-training  Focus group data was also collected at 3 points during the post-training phase

9.  Patient outcomes measured were: ◦ Out of hours mortality ◦ Out of hours discharges ◦ Length of stay ◦ Critical incidents ◦ Jobs handed over to on call teams and completion rates out of hours In addition, a convenience sample of handovers were filmed to look for adherence to taught handover methods

13.  TSCI demonstrated a statistically significant increase in scores (p=0.0028) and in those questions specifically relating to handover, a further statistically significant increase was seen (p=0.0094)  SBAR format was only used in 53% of handovers which were recorded. Leadership of handover was adopted in 100% of cases and the Think FIRST approach was adopted in 60%  No statistically significant difference was seen in mortality or length of stay. Critical incident analysis did not reveal any reduction in number of incidents, however in the post-study period, there were no system-based incidents reported out of hours

14. Focus group data and video recordings informed us of barriers to the use of SBAR and problems implementing the new changes, these included:  Lack of understanding of the relevance of training  Lack of senior and managerial support initially  Variability in training received by senior and junior grades

15.  Our educational intervention increased the completion rate of tasks undertaken out of hours and increased out of hours discharges  Staff satisfaction was statistically significantly increased by handover training and a participatory process of implementation  Barriers to implementation were successfully managed with a participatory approach  System based critical incidents may also be reduced by handover training and e-handover

16.  This study was financially supported by Health Education England as part of the Better Training Better Care Pilot process  Many thanks to the Leighton Hospital project steering committee for their support and assistance

17. 1. WHO collaborating centre for patient safety solutions. Communication during patient hand-overs. Patient safety solutions. 2007;1(3). 2. Toeima E. SHARING- improving and documentation of handover: Mind the gap. Journal of Obstetrics and Gynaecology. 2011;31:681- 682 3. Safe handover: safe patients- Guidance on clinical handover for clinicians and managers. British Medical Associated Junior Doctors committee (in collaboration with the National Patient Safety Agency). 2004. 4. Ye K, McD Taylor D, Knott JC, Dent A, MacBean CE: Handover in the emergency department: Deficiencies and adverse effects. Emergency Medicine Australasia. 2007;19:433-441 5. The Royal College of Surgeons of England. Safe handover: guidance from the working time directive working party. 2007. 6. Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. Medical Education. 2011; 45(11):1081-9 7. Center for healthcare quality and safety. University of Texas Health Science Center at Houston