Development and implementation of a standardised emergency department intershift handover tool to improve physician communication

BMJ Open Quality

article

Edmund S H Kwok¹  Glenda Clapham¹  Shannon White¹  Michael Austin²  Lisa A Calder² 

[1] Department of Emergency Medicine , Ottawa Hospital;Department of Emergency Medicine , University of Ottawa;Department of Emergency Medicine , Ottawa Hospital Research Institute

关键词: patient handoff;    hand-off;    emergency department;   

DOI  :  10.1136/bmjoq-2019-000780

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Structured handover can reduce communication breakdowns and potential medical errors. In our emergency department (ED) we identified a safety risk due to variation in quality and content of overnight handovers between physicians.Aim Our goal was to develop and implement a standardised ED-specific handover tool using quality improvement (QI) methodology. We aimed to increase the proportion of patients having adequate handover information conveyed at overnight shift change from a baseline of 50%–75% in 4 months.Methods We used published best practices, stakeholder input and local data to develop a tool customised for intershift ED handovers. Implementation methods included education, cognitive aids, policy change and plan-do-study-act cycles informed by end-user feedback. We monitored progress using direct observation convenience sampling.Measures50% of handover components communicated per patient) per overnight handover session. Tool utilisation characteristics were used for process measurement, and time metrics for balancing measures. We report changes using statistical process control charts and descriptive statistics.Results We observed 49 overnight handover sessions from 2017 to 2019, evaluating handovers of 850 patients. Our improvement target was met in 10 months (median=76.1%) and proportion of adequate handovers continued to improve to median=83.0% at the postimprovement audit. Written communication of handover information increased from a median of 19.2% to 68.7%. Handover time increased by median=31 s per patient. End-users subjectively reported improved communication quality and value for resident education.Conclusions We achieved sustained improvements in the amount of information communicated during physician ED handovers using established QI methodologies. Engaging stakeholders in handover tool customisation for local context was an important success factor. We believe this approach can be easily adopted by any ED.

【 授权许可】

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