1. Learning To Make a Difference Instituting a System of Formal Weekend Handover Wijetilleka S.*, Khakoo I.*, Weerasuriya CK.* Department of Chest Medicine, Papworth Hospital NHS Foundation Trust Supervisor: Dr Uta Hill * Equal Contribution Results 1.Handover meeting & attendance Meeting established on Friday 9 Jan, 1630-1700. Attendance: initial lack of representation from CF and LD (8 Jan / 23 Jan) – trainees not released for meeting. PDSA cycle 1: Consultant meeting – informed to release trainees. PDSA cycle 2: Institution of attendance recording sheet. Result: April 2015 – Attendance 100% 2.Handover storage. Electronic location allocated for storage of electronic handover sheets. 9/16 January 2015: RCP proforma deployed, with concomitant training session on completion. Trainee feedback – time consuming, no additional benefit. PDSA cycle 1: Revert to using modified ward lists as handover documents. Result: At all audited points (below) – documents stored from all sub-departments. 3.Handover content PDSA cycle 1: April 2015 – trainee email as reminder to include DNACPR information. Result: Marginal increase in DNACPR information. 4.Staff survey Marginal increases in staff confidence in areas of handover safety, consistency, content and resulting preparation [data on request]. Differences Made & Next Steps Key outcome: Established regular weekend handover meeting with attendance recording and auditable record of handover. Key next step: Handover content targets not met – target for improvement at sub-departmental level. Background The Department of Chest Medicine at Papworth Hospital weekend out of hours cover (Friday 1700 – Monday 0900) is provided through two on-call doctors working twenty four hour partial shifts. The first provides cover from Friday 1700 – Saturday 0900 & Sunday 0900 – Monday 0900; the second provides cover from Saturday 0900 – Sunday 0900. Prior to this QIP, there existed no formal mechanism of handover from Friday day-teams to out of hours staff. Handover sheets from each of Chest medicine’s five sub- departments (Lung Defence [LD], Cystic fibrosis [CF], Respiratory Support/Sleep [RSSC], Thoracic oncology [Onc] and Pulmonary Vascular diseases [PVDU]) are left as appropriate in the joint doctors office. There is no long term storage of handover sheets for audit. Aim To institute a system of formal handover to weekend out of hours medical staff, from Friday day-teams. The projected timeline is January – June 2015. Changes 1.Scheduled handover meeting takes place 1630 – 1700 every Friday, with recorded attendance from each of the above sub-departments and both in-coming on-call doctors; 2.Handover sheets must be stored on a shared network location for record keeping and audit; 3.The content of handover sheets to be audited against RCP criteria (below); 4.Staff confidence in handover processes be measured prior and post-implementation of the system. RCP Criteria for handover content: 3 patient identifiers (name, CRN and date of birth) [Target = 100%] Ongoing clinical issues [Target = 100%] Weekend tasks/plan – either 1) specific tasks for weekend teams or 2) if no specific tasks, the current ongoing treatment over the weekend must be clearly and separately demarcated [Target =100%] Date Dec 201413 Feb 2015 20 Mar 2015 10 Apr 2015 24 Apr 2015 Patients handed over (total) 34 (%) 29 (%) 26 (%) 29 (%) 30 (%) Adequate patient ID 2264.72172.42284.62069.02170.0 Current clinical issues identified 2676.52689.72492.32793.12996.7 Weekend specific plan indicated 2470.62069.01869.22069.01860.0 Resuscitation status/escalation noted 12.900.00 0 26.7