“Where’s the Bleep?” Improving Crash Bleep Handover

Dr Shivani Rae, Dr Dominic Sykes, Dr Sebastian Spencer, Dr Shoaib Faruqi

The Problem

A lack of formal weekday morning medical SHO handover posed a risk to patient safety through crash bleeps being left unattended.

At baseline:

• 4% of SHOs felt there was an effective handover

• 85% had found a crash bleep unattended

• 56% had witnessed a crash call on an unattended bleep

• 17% of crash bleep tests were responded to

Aims

To introduce a new handover system to improve patient safety and doctors’ satisfaction over 6 months, aiming for:

• 80% of crash bleep tests to be answered

Methods

Over 3 PDSA cycles, we developed an SOP for a new formal morning medical crash bleep handover. Surveys were conducted amongst SHOs at baseline (n=27), cycle 2 (n=17), and cycle 3 (n=18). PDSA cycles below:

In cycle 3:

Improvements

Satisfaction

• 83% felt the handover improved patient safety

• 78% felt it made it made bleep handover quicker and easier

• 67% felt it was an effective handover

To develop formal crash bleep handover

Pilot handover process (May 2022)

Bleep test response rate data collected (June 2022)

Suggested edits made to handover process

To assess the sustainability of the handover model

Daily staffing emails sent to SHOs and RMOs (July 2022)

SHOs resurveyed (July 2022)

Handover process relayed to new starters at induction

To assess the effect of medical registrar presence

Medical registrar presence mandated (Aug 2022)

Improved junior perception

Unattended bleeps

The proportion of SHOs reporting seeing unattended bleeps decreased from 85% to 28%, and witnessed crash alerts on unattended bleeps decreased from 56% to 17%.

4% 59% 67% 0 10 20 30 40 50 60 70 80 Baseline Cycle 2 Cycle 3 SHOs who feel handover is effective (%) Perceived Effectiveness of Handover 85% 29% 28% 56% 6% 17% 0 10 20 30 40 50 60 70 80 90 Baseline Cycle 2 Cycle 3

% medical SHOs reporting finding an unattended crash bleep % medical SHOs reporting witnessing a crash alert on an unattended crash bleep

Bleep Test Responses

Response rate to switchboard crash bleep test calls increased from 17% over 1 week at baseline to 52% over 1 week in cycle 1.

Conclusions

This simple cost-effective intervention led to sustained objective and subjective improvements in medical crash bleep handover, demonstrating the ability of junior doctors to identify and improve systems-level issues. The next step is ensuring these improvements persist despite regular junior doctor rotations.

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