Presentation on theme: "Clinical Handover Presenter: Ned Douglas"— Presentation transcript:
1 Clinical Handover Presenter: Ned Douglas Innovation Poster SessionHRT1215 – Innovation AwardsSydney11th and 12th Oct 2012Clinical Handover Presenter: Ned DouglasHealth Service: Melbourne Health1
2 KEY PROBLEMFindings 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
3 AIM OF THIS INNOVATIONTo 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.
4 BASELINE DATA 2010 Root Causes What does this Mean? No Melbourne Health Handover GuidelinesLack of standardised handover content, process and documentation across Melbourne Health:No minimum standards regarding contentNo specified time or place for handoverNo handover template for documentation purposesCompeting CommitmentsLack 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 rosteringLack of paid handover time, potentially resulting in lack of or poor handover.Decrease in JMS after HoursHandover required to multiple units resulting in less time available for handover per unit, potentially resulting in lack of, or ineffective handover
5 KEY CHANGES IMPLEMENTED Focused on Afternoon Handover in Specialty Medicine, the worst performing time for the worst performing units.Protected Handover timeInternal, Melbourne Health, handover guidelines were developedHandover education was given to all parties involved in handoverStandardised documentation in the form of an electronic handover tool was providedDesignated location: ward in specific locationStandardise content (ISBAR) was requiredStandardised process was agreed upon by units involved and followed
7 Compliance to MH Handover Guidelines for DOCUMENTATION was 98% OUTCOMES SO FARPilot – 2011Medical After Hours 2Compliance to MH Handover Guidelines for DOCUMENTATION was 98%Handover FormsDocumentation template (handwritten) given to each cover doctor.Despite compliance with documentation template there was no process to keep this informationTherefore, there was still low accountability for information handed over – an electronic handover tool has been developed as a solution
8 Comparison of change of Adherence (%) to VQC Criteria OUTCOMES SO FARImprovementAll unitsComparison of change of Adherence (%) to VQC CriteriaMeasureControlChangeMorning54%62.5%+ 8.5%Afternoon39%60.3%+ 21.3%Night58%70.3%+ 12.3%Specialty medical units increased from 23% to 62.5% (VQC Criteria) following improvement.
9 LESSONS LEARNT Support from senior clinicians is vital Clarity around expectations on a very specific process level helped drive improvementWhere existing processes were adapted, the best compliance was seen