Weekend Handover Understanding the Problem

1 1 Junior Doctors in Bronglais General Hospital identified that the weekend medical handover had difficulties: no protected time, no designated place for handover, no senior involvement, multiple paper lists, two separate handovers This was impacting negatively on the Juniors’ wellbeing and patient safety

1 2 The project aimed to focus on making weekend handover safer and more efficient

1.3 A fishbone and process map were used to help understand the problem and identify positionality of work.

SMART Aim

4 1 75% of weekend medical handovers to happen in a designated place and time with the entire on-call team present within three months, measured by using time keeping and survey, to improve patient safety and junior doctors’ well-being

PDSA Ramp

5.1 Continuation of discussions among the Junior Doctors, members of QIP team surveyed and shadowing the F1 on call for data gathering Involving rest of stakeholders in gathering informal feedback

5 2

Stakeholders

2 1 We identified our stakeholders by exploring Junior Doctors’ opinions and concerns We involved Medical Education and liaised with the QI team at BGH After discussion with juniors, we involved the medical consultants and the management team

2.2 All foundation doctors at Bronglais General Hospital are involved in the development of the project

2.3 The project falls within the engagement and involving people stage of the Ladder of Co-production

Measures

3 1 Outcome - Number of handovers in designated place and time at handover taken

3 2 Process measure(s) – Attendees, issues identified, and time taken

3.3 Balance measure – Staff well-being (post-handover and postweekend surveys)

PDSA 1: Specific time and place

PDSA 2: Handover training

PDSA 3: Use of Teams channel for handover

PDSA 4: MAU team engagement

PDSA 5: Dedicated safe space and time

5.3 Adapt:

• Access to quiet/protected space is essential, as well as more time allocated to the handover Junior doctors felt a significant improvement in their sense of wellbeing with a Senior Doctor present to help clarify and prioritise jobs

• There will be a need to digitalise the system

• Standardisation of handover: o Unified weekend jobs list with prioritisation of jobs o Standardisation of priorities for an easy navigation of said list e g a colour coding system o A standardised Friday ward round template sheet for each medical ward/team to add to the patient's notes, which will allow the on-call doctors seeing a patient for the first time to have a quick overview of the case

Reflection and next steps

6.1