Improving patient safety during medical handovers at Torbay Hospital

Introduction

Torbay Hospital is a 500-bed district general hospital in Devon.¹ Medical handovers occur twice daily but are not standardised. They involve medical ward doctors and the acute medical team responsible for admissions. This step in the patient pathway provides an opportunity for information to be lost, compromising patient care. This is particularly relevant for unwell patients – both new admissions and inpatients.

Colleagues' anecdotal comments suggested that unstructured handovers made it challenging to share information effectively; concerns were raised about patient safety. Research found that communication errors contributed to around two-thirds of notable clinical incidents; over half of these related to handovers.² The National Institute for Health and Care Excellence concludes that structured handovers can result in reduced mortality and length of admission, and improve staff satisfaction.³

The project aim was to improve the evening medical handover by designing and implementing a standardised handover proforma. We looked to improve doctors' satisfaction with handovers and their opinions on patient safety, as judged by their survey responses.

Materials and methods

The study gathered quantitative and qualitative data through surveys; asking doctors' opinions on important aspects of medical handovers based on the Royal College of Physicians Acute Care Toolkit.⁴ Surveys were distributed to doctors of various grades at the evening handover. They comprised eleven statements with a Likert scale of 1–10 (1 being strongly disagree and 10 strongly agree). The first 20 responses were analysed by calculating a mean rating for each statement, to ascertain baseline data and post-intervention data.

The primary intervention was implementing a proforma to be used at every evening handover, which the night registrar leading the handover could follow. It was brief to increase engagement and was printed and displayed in the handover room.

Results and discussion

Post-intervention data showed improvements in mean ratings for several statements: ‘Handovers have a positive effect on patient safety’ n = 7.4 to n = 8.6 and ‘I feel able to handover unwell patients’ n = 8.6 to n = 9.4. Fig 1 displays the changes in mean ratings for all statements. Qualitative data highlighted the proforma's variable use. A second intervention therefore involved distributing a poster of the proforma to registrars (Fig 2), raising awareness and encouraging consistent use. Feedback from this cycle displayed satisfaction with the proforma, but concerns remained regarding inconsistent implementation. A third cycle is ongoing to address this inconsistency.

Fig 1.

Mean pre- and post-intervention scores for survey statements.

Fig 2.

Poster of handover proforma.

Conclusion

While it's difficult to measure the project's impact on patient safety, results show that staff felt an improvement in communication and, as detailed above, communication between staff impacts patient safety.

This project highlighted that not all interventions create the expected outcome. Confounding variables impacted the project's success; change of handover venue made the poster more inaccessible and this likely affected its use. Furthermore, the junior doctor cohort changed during the project, according to the national training programme. This new cohort, with differentlevels of experience, may have impacted the results.