1. Improving handover in the ED setting “SBAR“

2. Objectives of the “SBAR Squad from A&E” Where we are Where we need to be What do our staff think How far have we got Where are we going

3. TAPS questions (Additional) “The SBAR Squad from A&E” What we were trying to achieve and why it was important: What worked well: What we have learned to take this forward:

4. Where we are?

5. Our Objective: To deliver high quality, evidence-based, effective, efficient and patient-centred care for ALL patients in the Emergency Department. PHASE 1 INITIAL ASSESSMENT Assessment - initial (complaint, physiology and allocate prioritisation) Planning - (investigations needed/ ordered, obvious decision to admit - DTA, start now if appropriate) Treatment - (immediate treatment/ resuscitation required) PHASE 2 DETAILED ASSESSMENT & TREATMENT Detailed assessment Chase results of investigations ordered Instigate further investigations if required EARLY Start treatment plan Management plan defined and delivered (with diagnosis, treatment plan and discharge plan) PHASE 3 MANAGEMENT & DISCHARGE PLANNING PHASE 4 ED EXIT – PLANNING & DELIVERY –SBAR Start Processes To: A) Discharge Home from ED using SBAR B) Admit to In-hospital Specialty Bed Base SBAR C) Admit to ED Observation Ward/CDU SBAR If delay in discharge from ED for any reason, inform appropriate person. TARGET TIMES TO SEE A DOCTOR DAILY & WEEKLY PERFORMANCE RESULTS FOR EACH PHASE STRATEGIC PLANNING AND EVALUATION IN THE EMERGENCY DEPARTMENT 0-15min window 15mins-90mins Window 90mins-3hrs Window 3-4hr window ED Senior Nurse SBAR ED SpR or Cons SBAR Duty Bed Manager If there is a breach (>4hrs in the Dept) in your area, please identify ways to prevent it in the future) Category 1(Resuscitation) =Immediate Category 2(Emergency) = Within 10mins Category 3(Urgent) = Within 1hr Category 4(Non-urgent) = Within 1hr Patient arrival to discharge MUST BE WITHIN 4 HRS for all patients. If delay in discharge from ED for any reason, inform appropriate person. Our Target:

6. What are the causes of error Fletcher NPSA 2008

7. Juliette Cosgrove: Q. “are we reporting enough?”

8. UCD IR1s 2011 [chart]

9. Knowledge application Process & system design Measuring success Teamworking & LEADERSHIP Training Where we need to be

10. What do our staff think? “a methodical order: name, age, gender, condition, plan, any risk to staff or patient” - nurse, grade 5. “simple clear patient details - complaint \ problem \ plan \ what needed \ & additional info.” – CSW. “everyone needs to handover following the same structure in the trust.” – Sister grade 6. “any further documentation needs to be short & concise. Already stress on 'time factors' with many other requirements for patients in ED; throughout [ED] stay and d/c to ward.” – Sister grade 7. “S: PC B: Meds & PMH A: impression / exam R: plan“- SpR in ED.

11. What do our staff think? Q1. The Emergency Department is a busy environment where the safety systems in place are robust and require no change. Please indicate the level of risk you perceive to be associated with the following patient events : Q12. Discussion with other speciality nursing or medical colleagues In the hospital. 1 Strongly Disagree 2345 DisagreeNeutralAgree Strongly Agree 12345 Low Risk Moderate High Risk Risk

12. How far have we got? Audit ( ED Cons Shift Team Leader snapshots x2) SBAR templates for key areas of the ED Developing context specific SBAR

13. Audit of practice Applied a development SBAR tool ( sticker in the ED notes) 10% and 15% adherence – not good! Positives: –Allowed refinement of tool –Embedded SBAR in minds of staff –Led to discussion and outcome to embed in ED notes

14. EMERGENCY DEPT PLANNING & HANDOVER Situation Likely diagnosis & other possible Dx? Background Co-morbidities? Assessment Present physiology (MEWS, GCS)? Active problems Investigations completed & those still required? Recommendations Acute therapy given? Further therapy required and when? Handover to (their name, grade, specialty) : Your name, grade & time of referral? SBAR template embedded into ED Notes

15. Senior Handover SBAR

16. SBAR for CDU protocols

17. S SITUATION  Name  Age  Consultant  Diagnosis  Treatment / Interventions  Resuscitation Status _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ ____ B BACKGROUND  Relevant medical history / surgical history  Medical / AHP consultations  Previous tests / treatments  Psychosocial issues  Allergies _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ ___________ A ASSESSMENT  Physical assessment  Mental health assessment / cognition  Vital signs / O 2 requirements  Lines - IV, CVC, PICC, Arterial  Pain score / analgesia  Wounds / pressure ulcers  Drains or tubes  Mobility  Nutritional status  Risk assessments (MEWS, MUST, VIP scores, MRSA/ decolonisation status and falls assessment.)  Pathology results  Patient /carer education _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ ___________________________________ R RECOMMENDATION  Care plan /care pathway  Orders needing completion  Pending treatments or tests  Discharge planning _____________________________________ _____________________________________ _____________________________________ _____________________________________ ______________ R READBACK  Oncoming staff (listener) confirms understanding of recommendations _____________________________________ _____________________________________ _____________________________________ _____________________________________ ______________

18. Where are we going! Embedding SBAR into ED notes Developing context specific SBAR within umbrella of improved handover Development of better communications with rest of hospital around SBAR Developing a tool for adherence and quality of content of SBAR in context specific situations