Delivering enhanced training in what makes an effective handover
In partnership with Health Education England, Mid Cheshire Hospitals NHS Foundation Trust’s project aimed to improve the clinical handover of patients to ensure they benefit from better continuity of care and improved safety
Medical handover continues to be an issue for discussion by national healthcare bodies such as the World Health Organisation (WHO) and the Royal College of Physicians (RCP), as well as individual trusts on a local level.
Before implementing the project at Mid Cheshire, handover from the acute medical unit and on medical wards consisted of using job books on each ward alongside verbal and written requests from the day teams. The team found that this approach resulted in multiple problems, for example there was no clear audit trail to ensure that tasks had been completed and a risk of unintentional confidentiality breaches associated with paper-based handovers.
How they did it
The project delivered enhanced training and education to medical trainees around what makes a good clinical handover, including accountability and ownership of patients and tasks, leadership, task prioritisation and time management. This included modifying the structure and standardisation of the handover process using good practice guidelines from the Royal College of Physicians and the situation, background, assessment and recommendation (SBAR) model. It also introduced an e-handover tool to support the capture of tasks, effective allocation and recording timely completion on the acute medical unit. To ensure effective delivery, a phased approach to implementation was taken which was overseen by a monthly steering group.
Who was involved
A steering group met monthly and the internal project team met on a weekly basis. The project team was made up of a clinical lead, core medical trainee, IT project manager and a service development lead. Throughout the lifecycle of the project, process mapping, action plans and timelines were used to develop new processes and deliver to timescales.
What they achieved
- A 43% increase in handover of tasks and completion
- A statistically significant increase in staff satisfaction as measured by validated teamwork and safety climate questionnaires
- Increased productivity and number of jobs handed over recorded by the e-handover system
- Focus groups noticed greater consultant attendance at handover meetings
- Video observations showed clear leadership in the handover process at 100% of meetings
- Focus groups noted that they felt patient safety was much improved by the new system.
What they’ve said
“Mid Cheshire has been privileged to be selected as a pilot site by HEE for our medical e-handover project and we are delighted with the results so far, in supporting doctors to improve safety and reduce the potential for harm during what is well known to be a period of high risk. There are many benefits that we have seen from this project however, I was struck by some of the less well recognised aspects such as opportunities for training. I am pleased with how the project has been embraced by our trainee medical teams and we are now looking forward to exploring future possibilities of use across the Trust and between differing healthcare professionals.”
Chief Executive Officer
“We don’t use it because we have to, we use it because we want to – it makes our lives easier.” –
“I have found the system easy to use, you get into a routine – when you refer a patient you add them to the system at the same time, which ensures that the coordinators in the assessment areas have visibility of the patient expected straightaway.” –
Emergency Department Clerical Coordinator
Please look at the toolkit materials in the related documents below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.
The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects.
Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.