Improving weekend handover between junior doctors on medical and surgical wards

Abstract

Poor weekend handover has been implicated as one of the causes of observed higher mortality rates at weekends in UK hospitals. In a large teaching hospital we, a group of junior doctors, set about improving the quality and effectiveness of weekend handover. We used the Model for Improvement to implement a weekend handover sticker through an iterative process using multiple Plan/Do/Study/Act (PDSA) cycles. Over the 16 week study period the number of completed weekend tasks increased by 30% and the number of patients with a documented weekend handover increased by nearly 50%.Junior doctors are well positioned to notice the quality and safety shortcomings within hospitals, and by using effective improvement methods they can improve these systems at little or no cost.

Improving Weekend Out Of hours Surgical Handover (WOOSH)

“…All of the studies have shown that the format of the intervention whether it is a hospital database, electronic system, sticker or weekend proforma all improve the handover on a weekend and ultimately patient safety. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 One study that used an electronic system reported up to 2 months before implementation of the new handover system could occur 6 , with other studies failing to comment how electronic systems affected the implementation of a new handover process. 5 , 8 , 9 .…”

“…The NHS is already stretched financially and this required no outsourcing from third party companies or other in-hospital services to provide the IT skills to proceed with the project as found in other studies 5 , 6 , 8 , 9 . Nor did it require the production of stickers 11 that would have to be monitored for stock levels. All the equipment needed was available on every ward.…”

“…In comparison, paper handovers placed in patient's notes incur negligible cost, are accessible, easy to use and require no training. 4 , 7 , 10 , 11 The traffic light system has been used to state the medical stability of a patient or the grade of doctor to undertake a patient review. 6 , 7 Both systems have trialed the use of traffic light or colour-coded systems with variable results.…”

Improving surgical weekend handover

“…Concerns about the safety and efficacy of in-hospital weekend handover are long-standing and have been addressed by junior staff at other hospitals in other quality improvement projects ( 6 , 7 , 8 , 9 , 10 , 11 , 12 ). Systems that are entirely paper based have been identified as disorganised, lacking in information and often illegible ( 6 , 7 , 9 ).…”

“…It has been noted, however, that electronic handover systems may be difficult to implement unless commercial software is purchased and installed ( 11 ). Other strategies which have been trialled with mixed results include handover stickers ( 8 ) or proformas ( 6 , 7 ) in patients' notes. Both of these strategies improve the quality of information available to weekend teams but do not help with identifying patients in need of review or obtaining up to date patient location.…”