1. 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

2. 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

3. 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.

4. 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

5. KEY CHANGES IMPLEMENTED
Focused on Afternoon Handover in Specialty Medicine, the worst performing time for the worst performing units.
Protected Handover time
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

6. KEY CHANGES IMPLEMENTED

7. 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

8. Comparison of change of Adherence (%) to VQC Criteria
OUTCOMES SO FAR
Improvement
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.

9. 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