Are weekend handovers of adequate quality for the on-call general medical team?

Abstract

-Weekend handover is vital for patient safetypoor handover is a cause of avoidable adverse events. This study evaluated whether the quality of information handed over for patients requiring weekend review was adequate. Two external doctors imagined themselves as the doctor on-call and judged whether the handed-over information was adequate for each case. Of the 1,130 handovers evaluated, 867 were handed over using a computerised proforma and discussed at the handover meeting, 148 using the computerised proforma but not discussed, 30 handovers were handwritten. Of handovers of patient details and background information, 87.3% were judged of adequate quality by the first auditor and 86.0% by the second. Similarly 70.6% and 75.8% of handovers of action plans were of adequate quality. Use of computerised proforma and discussion at a handover meeting gave the highest percentage of handovers of adequate quality, however, there was room for improvement. Training in handover may improve communication. KEY WORDS: communication, handover, patient safety, sign-out IntroductionHandover of patients is of critical importance in good clinical care. With new working time directives, junior doctor shift work has increased. 1 Often doctors on-call at the weekend will be unfamiliar with patients needing review, 2 relying on information on handover sheets. Handovers need to be clear and time efficientcommunication failure as a cause of preventable adverse events and deaths has been a major concern of health systems for many years. [3][4][5] One study found 24 adverse events arising from 503 patient night handovers. 6 Common causes of such events were inadequate description of current patient condition, deficient anticipatory guidance and lack of explanation of rationale for management plans. Omitted content from handover was the most common cause of deleterious communication failure in another study. 7 Illegible handwriting can also be a problem.Queen's Hospital, Romford, is a large district general hospital with 340 general medical inpatient beds, 22 general and acute medical consultants and an average of 330 medical admissions each week. At the weekend there are nine junior doctors covering the acute medical take and the medical wards. It is only feasible to review a selected proportion of medical inpatients over the weekend. Given the importance of safe handover, a service evaluation of the quality of information handover for medical inpatients needing weekend review was conducted. Method Phase 1 -Entering of informationPatients needing weekend review were identified by their routine weekday team and their information entered onto an electronic database tool before 4pm on a Friday. Data fields included patient details, clinical background and action plan (Table 1).Paul E Pfeffer, specialist registrar in respiratory and general medicine, Queen's Hospital Romford, Barking Havering and Redbridge University Hospitals NHS Trust; Dilip Nazareth, specialist registrar in respiratory and general internal medicine, Liverpool Hear...

Accuracy of inter-hospital transfer information in Australian hospital administrative databases

“…40 Admission on weekends and at non-daylight hours are reportedly associated with poorer outcomes for patients and elevated medical and handover errors. [41][42][43] In contrast, we observed greater accuracy of data within these periods, consistent with a few studies reporting better communication and documentation. 44,45 Less workload and possible shift related modifications that might affect transfer pathway may have contributed to our results.…”

The Weekend Effect in Hospitalized Patients: A Meta‐Analysis

“…[24][25][26] Fewer or less experienced staff during weekends may contribute to inadequacies in patient handovers and/or handoffs, delays in patient assessment and/or interventions, and overall continuity of care for newly admitted patients. [27][28][29][30][31][32][33] Our data show little conclusive evidence that the weekend mortality versus weekday mortality vary by staffing level differences. While the estimated RR of mortality differs in magnitude for facilities with no difference in weekend and weekday staffing versus those that have a difference in staffing levels, both estimate an increased mortality on weekends, and the difference in these effects is not statistically significant.…”

Improving weekend patient handover

“…The problem identified is not unique to this district general hospital, but has been recognised by medical and surgical juniors at both secondary and tertiary centres [7][8][9][10] …”