The Importance of Handover in Intensive Care: A Quality Improvement Project

Dr Sharon Rajesh, Dr Mariya Rajesh, Dr Elizabeth Aloof, Dr Dao Jittasaiyapan, Dr Ahmed Nazari

Background

Effective communication between staff in the form of a handover has been a general practise throughout hospitals and often occurs during the changeover of staff at the beginning and end of shifts. The guidelines for the Provision of Intensive Care Services state that consultant lead ward rounds must occur twice a day with daily input from nursing staff, it was found that at Northampton General Hospital (NGH) Intensive Care Unit there is one handover and consultant lead ward round in the morning, an informal handover between day and evening staff and a formal handover in the evening which did not meet guidelines.

The Problem

The intensive care at Northampton General Hospital is split into 2 halves, East and West side. Doctors working on the day shift are heavily involved in patient care on one side of the unit, whereas doctors who work late shifts are expected to manage patients from both sides of the unit.

Currently, there is no formal handover between the morning and late shifts meaning that the late shift staff do not have up to date knowledge of issues occurring and decisions made on the opposite side.

A preliminary survey found that 41.7% of staff found the informal evening handover inadequate and 50% of doctors spend time at the beginning of their evening shift looking through patient notes.

What are we trying to achieve?

• Efficient communication between the day and evening staff as well as medical and nursing staff in order to maintain patient safety and ensure continuation of care.

• Any jobs missed during the day can be handed over efficiently. This will allow the late shift team to gain a clear understanding of the decisions made during the day and will aid patient safety.

Phase 1:

Changes made from phase 1

Phase 2:

Our Solution

• Phase 1: implement a 5pm ward round during the afternoon whereby the junior doctors, consultants and nursing staff would handover patients to the evening staff at each bedside.

• Phase 2 : Make changes and improve on our 5pm ward round using feedback from Round 1.

Results

• The handover time is fluid: anytime between 4pm-6pm

• Only the on-call consultant needs to join if the day shift consultant has already handed over

• Creation of a new jobs book to document the afternoon jobs created and follow up on any day jobs

Survey results found that after the round 100% were more confident in managing the patients at NGH ICU, 60% expressed that the afternoon round provided clarity regarding management plans, main problems and 100% of staff agreed that the round improved communication. During the first cycle 88% of jobs were completed, outstanding issues were identified, and jobs were created during the handover which otherwise would have been left for the next morning ward round. During the second cycle 91% of jobs were found to be completed

Conclusion

Twice daily ward rounds which include nursing and medical staff improve communication and confidence between staff and ensures the continuation of high-quality care throughout the day and night.