The Health Roundtable

Clinical HandoverPresenter: Ned Douglas

Health Service: Melbourne Health

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

1

The Health Roundtable

KEY PROBLEM

Findings from the “Hospital at Night” project indicate that shift to shift clinical handover between junior medical staff (JMS) at Melbourne Health (MH) occurred in an inconsistent manner and did not meet best practice guidelines.

Shift to shift handovers between JMS were only 52% compliant with Victorian Quality Council (VQC) criteria. This had the potential to negatively impact upon

patient safety and continuity of care.

2

The Health Roundtable

AIM OF THIS INNOVATION

To improve and standardise shift to shift handovers between JMS for all general and specialist medical and surgical units, emergency department (ED) and intensive care unit (ICU) at RMH City Campus and Royal Park Campus.

3

The Health Roundtable

BASELINE DATA

0%

20%

40%

60%

80%

100%

ICU ED Spec Surg Gen Med Royal Park Gen Surg Spec Med

Overall Compliance with VQC Criteria by Unit

0%

10%

20%

30%

40%

50%

60%

70%

Night Weekend Morning Evening

Overall Compliance with VQC Criteria by Time

2010Root Causes What does this Mean?

No Melbourne Health Handover Guidelines

Lack of standardised handover content, process and documentation across Melbourne Health:• No minimum standards regarding content • No specified time or place for handover• No handover template for documentation purposes

Competing Commitments

Lack of protected handover time potentially resulting in lack of, or ineffective handover.

JMS perception that evening handover time is at the end of the rostered shift (usually 5pm)

Poor utilisation of cross-over periods. Can result in a lack of handover occurring at all. Much of handover occurring after rostered handover time.

No Cross-over period because of rostering

Lack of paid handover time, potentially resulting in lack of or poor handover.

Decrease in JMS after Hours

Handover required to multiple units resulting in less time available for handover per unit, potentially resulting in lack of, or ineffective handover

4

The Health Roundtable

KEY CHANGES IMPLEMENTED

Focused on Afternoon Handover in Specialty Medicine, the worst performing time

for the worst performing units.

Protected Handover time 1630-1700

Internal, Melbourne Health, handover guidelines were developed

Handover education was given to all parties involved in handover

Standardised documentation in the form of an electronic handover tool was provided

Designated location: ward in specific location

Standardise content (ISBAR) was required

Standardised process was agreed upon by units involved and followed

5

The Health Roundtable

KEY CHANGES IMPLEMENTED

6

The Health Roundtable

OUTCOMES SO FAR

Compliance to MH Handover Guidelines for

DOCUMENTATION was 98% Documentation template (handwritten) given

to each cover doctor. Despite compliance with documentation

template there was no process to keep this information

Therefore, there was still low accountability for information handed over – an electronic handover tool has been developed as a solution

Handover Forms

Pilot – 2011Medical After Hours 2

7

The Health Roundtable

OUTCOMES SO FAR Improvement - 2012All units

Comparison of change of Adherence (%) to VQC Criteria

Measure Control Change

Morning 54% 62.5% + 8.5%

Afternoon 39% 60.3% + 21.3%

Night 58% 70.3% + 12.3%

Specialty medical units increased from 23% to 62.5% (VQC Criteria) following improvement.

8

The Health Roundtable

LESSONS LEARNT

Support from senior clinicians is vital Clarity around expectations on a very specific

process level helped drive improvement Where existing processes were adapted, the best

compliance was seen

9