Poster Group F - QI in Progress- BPSC2023

Ascitic Tap in the Emergency Department to improve outcomes for patients with suspected Spontaneous Bacterial Peritonitis

Authors: Petsios M, Majorino A, Harrison E

The clinical problem

The standard practice in Torbay Hospital was a cirrhotic patient who came to the Emergency Department (ED) with suspicion of Spontaneous Bacterial Peritonitis (SBP) would receive an early empiric antibiotic treatment but would not get a diagnostic ascitic tap by the ED team The ascitic tap would occur in an acute medical or a gastroenterology ward later in the patient’s hospital stay With the escalating waiting times to see an ED clinician and be allocated a hospital bed, ascitic tapping could be delayed severely resulting in suboptimal management and potentially dire outcomes It has also been shown that delayed paracentesis increases inpatient hospital stay and mortality for these patients1 According to guidance by the British Society of Gastroenterology (BSG), diagnostic paracentesis should be performed without delay when SBP is suspected and immediate empiric treatment with broad-spectrum antibiotics should be initiated2 An audit performed at the beginning of this project showed that one out of thirteen patients with gross ascites underwent a diagnostic abdominal paracentesis in ED and had been started on an appropriate antibiotic regime

Aim

This project focuses on the early diagnosis and treatment of SBP by ED clinicians to improve the standards of care and clinical outcomes for these patients - such as reduced mortality and hospital stay

Project Results

Investigating efficacy of pregabalin/gabapentin for lower back pain with or without sciatica at an Oxford GP

Joanna Yin Jie, Ting

Introduction

Lower back pain = largest single cause of disability in the UK Complications = chronicity, depression, disability, loss of employment.

Rates of spinal surgery referrals increasing yearly.

Current NICE guidelines (NG59) recommend against prescribing gabapentinoids for managing sciatica and low back pain to reduce the chance of adverse events and dependence

Treatments recommended include self-management, exercise, oral NSAIDs or low dose opioids.

Aims

To review efficacy of gabapentinoids in patients who have been taking it in the last 3 months in a GP Practice in Oxford for the treatment of lower back pain and to investigate if surgical referrals are made appropriately.

nausea

Side Effects Reported

Data Collection and Analysis

Conclusion

• Although >70% of patients found P/G to be helpful in back pain, many were also taking other strong pain medications such as opioids (confounding factor)

• Many noted drowsiness/tiredness as a SE Falls risk for elderly (~45% of pt were >65 y.o)

• Good documentation of medication reviews (dose, SEs reviewed regularly), pain medications that patient was trialed on before starting P/G, when dependance risk explained to patients

• 100% appropriate referral to surgeons as per NICE guidelines (Refer to a neurosurgeon or orthopaedic surgeon if there are red flags including progressive, persistent, or severe neurological deficit.)

Recommendations

A local meeting was arranged to educate GPs on using a new template pop-up on EMIS to encourage better documentation into reason behind starting gabapentinoids according to NICE guidelines

As per NICE guidelines, encouraged to provide people with advice and information, tailored to their needs and capabilities, to help them self-manage their low back pain with or without sciatica, at all steps of the treatment pathway Include:

• information on the nature of low back pain

• encouragement to continue with normal activities

Reaudit 2 months later showed comparable results alongside improved documentation of medication reviews

Limitations

• Small sample size

• Improper coding

• Limited documentation on whether patients were given sufficient information on self-management advice

https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/ https://www.ukssb.com/improving-spinal-care-project

https://cks.nice.org.uk/topics/sciatica-lumbar-radiculopathy/management/

Aim

“An Introduction to Critical Care”

care

Dr Michaela Monaghan

To provide foundation and SHO level doctors with a simple guide introducing them to critical care before the start of their placement, improving their preparedness, confidence and knowledge

Why is this important?

Starting any new rotation in medicine can be daunting

Exposure to critical care at medical school is limited, and often doctors at foundation years 1, 2 and SHO level starting in critical care have had little experience in this area of medicine

Providing important information prior to starting the job can improve confidence and knowledge, resulting in improved preparedness and increase in patient safety

Methodology

PDSA Cycle 1

PLAN/DO: A survey was circulated to foundation and SHO level doctors in critical care to assess their preparedness and confidence prior to starting their role, and also to assess feeling towards the existing induction information available

STUDY: 9 respondents

- median preparedness score was 2/5 - median confidence score was 3/5

- median knowledge score was 2/5

ACT: Development and distribution of “An Introduction to Critical Care” document

PDSA Cycle 2

PLAN/DO: Foundation and SHO level doctors were resurveyed before and after reviewing the new introduction document which was distributed via email before their start date

STUDY: 7 respondents - improvement in median preparedness and confidence post-intervention

- no median improvement in knowledge, however elimination of lowest score (1) was achieved

ACT: Distribution of document to all new starters at foundation and SHO level

Summary of Results

• Baseline results indicated a lack of confidence, knowledge and preparedness, and scope for improvement on the existing induction information sent out to new starters.

• 7 post-intervention responses received. 2 respondents reported not receiving the document, therefore were unable to respond to the follow up questions.

• Results after intervention showed an improvement in preparedness and confidence with dissemination of the new introduction to critical care document.

• No change in knowledge median score was demonstrated, however individual score comparisons showed an elimination of the lowest score (1) in post -document results.

Learning and Next Steps

Learning:

• FY1s and SHOs feel fairly low in confidence, knowledge, and preparedness prior to commencing their ICU jobs

• Access to an information document prior to starting can help improve preparedness and confidence but did not change median knowledge

• Collecting responses was challenging

• Some respondents said they did not receive the document

Next Steps:

• Present the document as part of the induction, giving doctors the opportunity to ask questions to help improve knowledge This also ensures all new starters have access to the document

• Give feedback form at the end of the session so doctors can respond with information fresh in their minds, and account for questionnaire fatigue as this is being done within the session instead of their free time

• Ongoing improvement of the document taking in to account any additional information doctors feel is pertinent for new starters based on their own experiences

Improving preparedness and confidence in FY1s and SHOs commencing a new placement in critical

Multidisciplinary formulation and family involvement on a psychiatric intensive care unit

Dr.Ahmed Amer, Dr. James McIntyre, Hannah Macdonald (2023)

Introduction

We present 4 PDSA cycles that relate to the development of multidisciplinary care planning on a psychiatric intensive care unit; with a focus on patient and family involvement. Outcomes were measured through qualitative feedback.

In 2017 the CQC identified key similarities in services that had developed successful reducing restrictive practice programmes (CQC1). These included a) involvement of the whole multidisciplinary team and b) tools that shape personalised care, in order to support and inform staff (Restraint Reduction Network, NAPICU2). In addition, a team formulation approach can encourage staff to consider life experiences, values, goals and needs of service users, developing more helpful beliefs and ways of responding as a team (Berry et al3). Individualised care planning using a team formulation approach was developed to achieve these goals.

During the COVID pandemic 2020-21 all family visits to inpatient psychiatric units were restricted in order to protect vulnerable patients. The Standards for Psychiatric Intensive Care Units, (Quality Network for PICUs4), require that patients and carers are involved in all aspects of their care. This is consistent with the recommendations of the Triangle of Care Guide, 20105. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness6 indicated that family involvement was linked to a 19% reduction in the risk of suicide for people with mental health difficulties.

The multidisciplinary formulation and care planning process was further developed so that, in addition, family involvement and the triangle of care were maintained in the absence of face to face contact.

PDSA Process

A multidisciplinary formulation groups was started on Ashdown Psychiatric intensive care ward (PICU). A qualitative exploratory study gathered staff feedback of the utility and limitations of this approach.

Through 4 PDSA cycles the project was further developed to provide a weekly written summary for patients and their families while they were an inpatient on Ashdown ward in Salisbury (Fig. 1).

Results

19 families responded to the questionnaire (Fig. 2), 18 (94.8%) found this helpful. When asked for feedback about the plan, families reported :

• Honesty where a lack of progress was described, was found particularly helpful.

• Regular detailed summary meant families less “on spot” when receiving a phone call from a professional.

• Families felt the offer helped maintain engagement when loved ones are in hospital for long periods.

• Would like to include the name of the primary nurse.

• Would like information about involved non NHS organisations.

Method: Cycle 4

A weekly multidisciplinary professionals meeting was held to develop an integrated, person centred care plan for patients in the Psychiatric Intensive Care Unit. The plan included sections on communication, self Care, nursing needs and primary nurse, leisure and occupation, medication and target symptoms, working diagnosis, medical tasks, psychological input, community access, discharge planning. A printed copy of the summary was shared with the service user by their named nurse and feedback sought.

Consent to share this information with family/carers was requested and family/carer address confirmed. An encrypted, password protected, care plan summary was e-mailed to named family members, or carers identified by the patient. Family and patient feedback from these, was incorporated into the multidisciplinary review process. This allowed a dynamic collaborative care plan, to develop, with changes made, based on combining patient, professional and family views.

At the point of discharge from the ward, a questionnaire was sent to families to gain their feedback on the utility of this tool.

Families were asked to provide qualitative feedback of their experience of the information sharing tool (Fig. 3).

Conclusion

Multidisciplinary formulation based care planning allowed greater consistency of care, as a detailed understanding of a patient’s needs was held by the whole team rather than solely by specific team members.

There was a time cost: a weekly two hour meeting was needed. However a proactive approach aims to reduce incidents and the need for reactive interventions. On balance the benefits outweighed the costs and the process continues to be used post pandemic.

It was notable that families were more involved in their relatives care, and contact with professionals was more frequent. Families particularly valued honesty; for example, where a lack of progress was described, as well as times where progress had occurred.

Fig. 2

Fig. 3

Fig. 1

A Closed Loop Audit of Venous Thromboembolism Prophylaxis in Gynaecology Ward of a Scottish Hospital

Mun Leng Lee, Iain Martin, Inna Sokolova Crosshouse Hospital

Venous thromboembolism (VTE) is a collective term for both deep vein thrombosis and pulmonary embolism. VTE can result in significant morbidity and mortality to patients, including gynaecology patients. Hospital-acquired thrombosis accounts for 50-60% of all VTE in adults.1

Assessing VTE risk in gynaecology patients can be challenging due to multiple factors:

• Younger demographic of patients

• May present with vaginal bleed

• Recurrent admissions

• Short admissions

1. To increase awareness regarding VTE risk assessment and appropriate VTE prescription in gynaecology patients.

2. To improve compliance of healthcare professionals in assessing and prescribing appropriate VTE prophylaxis in gynaecology patients.

3. To evaluate the impact of interventions that aim to increase awareness.

Four plan, do, study and act (PDSA) cycles were conducted over 18 months from August 2021 to February 2023.

• There is a large improvement in both LMWH and TED stockings prescription after initial interventions.

• Further improvement in compliance of appropriate VTE prescription is noted in cycle 3.

• The rate of correctly completing the entire proforma in the third cycle was poor with only 14.5% (n=7).

• The rate of compliance remains significantly better than preinterventions in cycle 4.

• The rate of correctly completing the entire proforma remains poor at 10% (n=3).

Background

Initial interventions successfully raised awareness about importance of appropriate VTE prophylaxis. In cycle 3, interventions involved regular memory aids and staff nursing involvement. Subsequent interventions aim to achieve good long term compliance of appropriate VTE prophylaxis assessment and proforma completion rate.

Cycle Interventions

• Introduction of VTE risk assessment column in handover sheets

• Local departmental teaching 1

2 3 4 14

• Introduction of VTE risk assessment proforma in clerking documentation

• Case-based discussion teaching sessions

• Posters

• Email reminders

• Teaching sessions on VTE amongst staff nurses

• Introduction of VTE teaching sessions at induction during changeover

2. High patient turnover with short admission

3. Ambiguity in indications of VTE prophylaxis

4. Regular changeover of doctors

Overall, this study has successfully increased awareness and appropriate VTE prescription in gynaecology patients despite poor completion rate of the VTE risk assessment proforma.

14 months after

Act Study 11 11 21 21 28 28 26 26 VTE Prescribed 3 (27.27%) 2 (18.18%) 10 (47.62%) 5 (23.81%) 24 (85.71%) 18 (64.29%) 14 (53.8%) 9 (34.62%) Not prescribed 8 (72.73%) 9 (81.82%) 11 (52.38%) 16 (76.19%) 4 (14.29%) 10 (35.71%) 12 (42.86%) 17 (65.38%) Trend of compliance over the course 4 cycles

1. Assess long term compliance and continuity of care with regular VTE teaching sessions for healthcare professionals

2. Larger sample size

3. Regular VTE teaching sessions at induction during handover

• Revised VTE risk assessment proforma to be printed on yellow papers after last intervention

last intervention

4. Revised VTE risk assessment proforma to be printed on yellow papers to improve completion rate

5. Review of completion rate VTE risk assessment proforma

Reference:

1) National Institute for Health and Care Excellence (NICE). 2018. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. https://www.nice.org.uk/guidance/ng89/ chapter/Context. [Accessed on 8th January 2022]

A Stratified Approach to QI for Optimal Cord Management for Preterm Infants

Aim: To introduce optimal cord management (OCM) for preterm infants in Portsmouth without compromising normothermia on admission.

Background: National bodies recommend deferring cord clamping for preterm infants. Promoting normothermia around the time of birth is a key audit measure of the National Neonatal Audit Programme (NNAP) and normothermia during the first hour of life is associated with better neonatal outcomes.

The Neonatal Intensive Care Unit (NICU) of Portsmouth Hospitals University NHS Trust has consistently been rated as excellent or outstanding in the normothermia NNAP measure.

OCM had not been used in Portsmouth prior to this project, partly due to concerns that it might compromise excellent normothermia outcomes.

Approach: Portsmouth was a negative outlier for deferred cord clamping in the 2021 NNAP report. Therefore, the evidence for deferred cord clamping was examined in an MDT:

Examining the Evidence

The Cochrane review of OCM in preterm infants1 is heavily reliant on one RCT.2

In this RCT, mortality in the control group was 9% and was reduced to 6.4% in the intervention (OCM) group. Mortality in Portsmouth for an equivalent cohort in 2022 was 3%, raising questions about the applicability of these data to a unit already significantly outperforming centres included in the study.

Considering the potentially limited applicability of this evidence to our population, deferred cord clamping was introduced cautiously. It was initially implemented in the more mature infants (born at or after 30 weeks gestation) with continuous review of normothermia outcomes contributing to decisions around extending the measure to more preterm infants.

What is optimal cord management?

The British Association of Perinatal Medicine (BAPM) and National Neonatal Audit Programme (NNAP) recommend that clamping of the cord should be deferred until at least one minute after birth for preterm infants born before 34 weeks of gestation.

It has been endorsed by the Maternity and Neonatal Safety Improvement Programme (NHS Improvement)

Progress: It was not practical to introduce DCC in Portsmouth during the COVID-19 pandemic. In 2021, 4.6% of infants born before 34 weeks of gestation received DCC. Between January and September 2022, DCC was implemented and the rate rose to 20.4%. From October 2022, a QI project promoted DCC to the MDT and DCC rose to 25.0% (October 2022 – February 2023). Normothermia rates remained stable after DCC introduction (92.0% in 2021, 93.5% January-September 2022, 92.6% October 2022 – February 2023).

The Future: This project demonstrates the feasibility of a stratified approach to QI. It may be considered in other settings where new practices may compromise established excellence.

Having demonstrated success in introducing OCM to more mature infants without compromising normothermia, the QI initiative can be expanded to include less mature infants. This expansion of inclusion criteria will be accompanied by careful ongoing monitoring of any effects on normothermia outcomes for this more vulnerable cohort of infants.

1. Rabe H, Gyte GML, Díaz-Rossello JL, Duley L. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. 2019(9). 2. Tarnow-Mordi W, Morris J, Kirby

Dr Aneurin Young, Dr Olie Chowdhury, Dr Huw Jones Neonatal Intensive Care Unit, Portsmouth Hospitals University NHS Trust

Learning from Excellence:

Rewarding excellence in the workplace and boosting morale

L Elliott, A Watson, B Geers, S Knipe, E Gibbs, J Porter, O Rides Royal Devon & Exeter Hospital, Exeter, UK.

Background

The NHS Staff Survey 2022 identified low morale and high levels of burnout amongst NHS staff, with 34.0% feeling burnt out because of their jobs (1). Despite efforts to increase morale and improve wellbeing in recent years, only 42.1% of staff feel satisfied to the extent their organisation values their work (1). In a 2016 survey by the Royal College of Physicians, 50% of junior doctors identified low staff morale as a significant factor negatively impacting patient safety (2).

Learning from Excellence (LfE) is an initiative across Royal Devon University Healthcare Trust to improve morale and recognise excellent practice amongst staff. Staff members nominate others for actions that we can learn from, positively improve the work environment and patient care. Recipients receive a letter detailing their achievement and a thank you card.

Project Aim

We aim to increase the number of Learning from Excellence (LFE) staff nominations by 50% per month in the trust by March 2023 compared to March 2022.

PDSA Cycle 1:

Increase active awareness of LfE through in-person events at the Royal Devon and Exeter Hospital.

- Attendance at hospital ‘transformation hubs’

- Staff canteen stall

- Ward-based interventions

PDSA Cycle 2 (in progress):

Introducing a feedback form on nomination letters to measure the impact on staff morale.

Results

The number of nominations in March 2022 was 13. Following our first intervention (PDSA cycle 1) in early January 2023, nominations increased to 28, 36 and 54 in January, February and March respectively. This constitutes a 415% increase in nominations in March 2023 compared to March 2022.

Nominations increased to 30-60 per month for the first quarter of 2023.

Use posters and attend monthly ‘transformation hubs’ to ensure nominations remained high and to remind staff of the platform.

Conclusions & Future Work

We have collected preliminary ‘ad-hoc’ qualitative feedback from nominees. Responses included:

“It made me feel seen for all my hard work…it made me cry” - ward clerk.

“After a hard weekend on call, receiving a thank you card made me feel valued by my colleagues” - junior doctor.

Our interventions have increased nominations significantly within the trust. Next stages of the project include:

1. Maintain an LfE presence at monthly transformation hubs

2. Ward-based interventions to continue to raise awareness amongst staff

3. Collection of qualitative feedback to measure the effect of increased nominations on morale

4. A patient-facing form, allowing us to directly measure the link between LfE and patient experiences.

Optimising patient flow in community hospitals

R Fitchie, R Wallace, T Herbert and J Smith

Background

The Quality improvement process started to improve patient flow within community hospitals – improving inclusion/exclusion criteria, reducing length of stay, reducing number of patients not meeting the criteria to reside (nCTR) and discharging majority of patients to their home environment.

Our SMART aim

To reduce the length of stay in our community hospitals in Gloucestershire to an average of 28 days.

Ensuring the right patients are in the right place with the right multidisciplinary team at the right time in their care pathway by the end of 2023.

PDSA cycles

Acknowledgements

Holly Smith, Michele Slater, Juliette Richardson, Emma Wright, Cathy Wallace, Sarah Bieneman, Laura Graham, Denise Gillet, Emma Hamilton

PLAN DO STUDY ACT

1. Training for MDT on Criteria to Reside

Prediction- feedback will be positive, a improvement in understanding of CTR reporting will be seen

2. Develop Positive Risk Taking Guidance for staff in C.H.

Prediction- reduction in Length of stay (LoS) from admission to nCTR, higher levels of confidence with risk taking approaches

3. Streamline discharge for Patients and Families

Prediction- families will feel empowered and more informed. Length of time from decision to discharge to date of discharge will reduce

Measurement

Training presentation developed, rolled out to small group Compare results from group training. There is an increase in confidence shown from questionnaire data.

Design pathway that encourages positive risk taking with patients/family/staff

Implement pathway in MDT discharge planning meetings, utilise positive risk taking ‘champions’ for individual support, measure and compare confidence levels (informal interviews) and LoS (adm. to nCTR)- initial data shows reduced LoS (Nov 2022 compared to April 2023)

Expand training, utilise “champions” in each area to support message of importance of reporting.

Ongoing PDSA cycles following this cycle

Expand measures of staff competence. Expand to encourage risk taking in other wards using pathway

Ongoing PDSA cycles following this cycle

Improve links with transport team, and families around facilitating discharge once decision to discharge has been made.

Training for MDT on CTR - % improvement on questionnaire pre/post training session (pre session = Blue, post session = orange)

Develop Positive Risk Taking Guidance - reduction in length of time between admission and nCTR decision

Data collection in progress

Length of time from decision of discharge to actual discharge has reduced in the study ward area from Nov 2022 to April 2023.

Lessons learnt

Ongoing PDSA cycle

• Confidence versus competence learning

• Structured approaches to supporting staff in positive risk taking and discharge decision making is paramount

• Using a structured approach to QI work (Model for Improvement) is key to sustainable success!

• More heads from a wide project group helps with creating change ideas and sharing the work

Next steps

Discharge information for patients/families – length of time between decision to discharge and date of discharge.

• PDSAs in progress currently (as above) including 2 new onestesting a ‘structured’ MDT discharge planning meeting approach with the aim of increasing efficiency and completion of discharge plans

• New data collection plans

• Expand PDSA outcomes to other ward areas using developed resources

Admission and Discharge Summaries Audit

Are we up to date?

Background

Admission and discharge summaries are vital for the continuity of care and patient safety in the community. Admission summaries should be sent to Community Consultants and GPs in the first week after admission. Discharge summaries should be sent as soon as possible after discharge, within one day. Administrative staff held a meeting with the junior doctors informing them that the previous junior doctor teams had not consistently met the Trusts with some wards accruing a significant backlog of admission / discharge summaries.

Aims

This audit aimed to identify the:

• Proportion of mental health inpatients who had an admission / discharge summary.

• Proportion of summaries completed within the required time periods.

• Average time, in days, taken for admission / discharge summaries to be completed.

Sample / Data Collection

• Only admission / discharge summaries due to be completed over the study period 3/8/2022 –21/10/2022 were audited.

• A proforma based on the Trusts Discharge and Transfer Policy and admission standards as set out in the junior doctor handbook, was used to collect the data.

• 30 admission and 28 discharge summaries were audited.

Action Delivery

Introduce a new interactive spreadsheet warning junior doctors which summaries are due/urgently pending.

Create file with the assistance of the IT department. Show staff how to best utilise software, and reaudit once spreadsheet has become embedded in practice.

Develop formal admission summary guidelines Audit presented to all the members of the trust at a local meeting. Clinical lead in support of the idea for new guidelines, we are working together to produce the guideline.

During induction lectures, present this audit and specifically instruct the junior doctors what the guidelines are for admission/summaries.

Lessons Learnt

• Importance of valuing all members of the Trust. The secretaries initially raised this issue which prompted this audit.

• This audit unearthed the lack of clear Trust guidelines regarding the completion of admission summaries.

Once new guidelines are developed, the results of this audit will be presented alongside new guidelines. This has been discussed with the clinical lead, head of education and admin staff arranging induction meetings.

• We found it difficult to balance audit/ clinical work, this meant we exceeded our original timeframe. In the next round we will have more checkpoints incorporated within the audit process.

Author: Nishant Aggarwal Clinical Lead: Ashok Kumar

Background

What was the problem?

A Quality Improvement Project to Improve Handover in a Tertiary Orthopaedic Spinal Department

Alisha Bhanot1, Jamie O’Callaghan2, Karim Aboelmagd1, Jessica Pridmore1, Marie Gibson1, Neil Upadhyay1

1 Southmead Hospital, North Bristol NHS Trust, Bristol

2 Gloucester Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester

• Poor communication in healthcare compromises patient safety

• Effective handovers allow for prioritisation of care and timely reviews

• Live inpatient list located on a word document on a shared drive

• Inpatient list contained handovers for out of hours teams

• Incidents identified where doctors were unable to access the live list and access handovers, including a near miss of a patient post-op review

Aim

To improve the safety of handovers in a tertiary spinal department, focusing on access to the inpatient list and communication with the multidisciplinary team (MDT)

Initial Results

Junior doctors (n=8):

The list is easy to access: 100% (n=8) “disagreed” or ”strongly disagreed”

Able to identify current patient issues: 75% (n=6) “disagreed” or ”strongly disagreed”

No responders knew how to update clinical information, add or remove patients from the list.

Using Careflow would improve patient safety: 100% “agreed” or “strongly agreed’

Methods/PDSA (2)

1. In response to the survey results, the inpatient list and handovers were migrated to the integrated care system CareFlow

2. Development of an information sheet for handovers

3. Further survey sent to doctors and nursing staff

Post-intervention Results

I feel confident accessing the inpatient list and handovers

All responders “agreed” or “strongly agreed” that the new list and handover system:

Improved patient safety

Improved handovers

Improved communication with MDT

• No Foundation Year 1 doctor had problems finding/accessing handovers

• No reported incidents of clinical handovers missed

• Confidence in updating clinical information improved (100% (n=7) had confidence post-intervention vs. 0% preintervention)

unable to access live list

unable to identify patients and retrieve handover

patient care compromised

Methods/PDSA (1)

1. Initial survey of doctors working within/covering spines out of hours to assess perceptions of current list and handover system

2. Initial survey of nursing staff to assess communication with MDT

Felt informed of current patient plans: 75% “strongly disagreed” or “disagreed”

staff (n=4):

Outcomes:

Felt clear when patients were ready for discharge: only 25% “agreed” or strongly agreed”

Daily updates on Careflow would improve patient safety and flow: 100% “strongly agreed”

1. Confidence and ability of doctors in accessing the inpatient list and retrieving handovers, including out of hours

2. Incidence of clinical handovers being missed

3. Communication with members of the MDT

100% of responders thought the new handover system improved improved patient safety and flow.

Awareness of when patients were ready for discharge improved (80% were aware postintervention, compared to 25% pre-intervention)

Main messages

• A migration to Careflow for handovers within orthopaedic spines improved:

1. Confidence in accessing handovers à reduced likelihood of errors and missed clinical reviews

2. Improved communication within MDT à earlier identification of when patients were ready for discharge à improved patient flow

• Discrepancies in how often the handovers were updated

Challenges

• Further intervention required to explain the importance of daily handovers to new doctors rotating through spines

• Assess whether changes can be sustained over a rotation of junior doctors

Next stage

• Deliver a talk on the new handover system during induction for new doctors rotating through orthopaedics