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Improving Out of Hours Patient Safety
a Weekend Handover Proforma
S.Arun FY1Gen. Medicine Jersey General Hospital
Background Best practice RCP Guidelines Widely accepted in UK teaching hospitals Improves continuity of care
Between Day & Out-of Hours teams Between firms
Re-appraises cases weekly Helps when formulating a referral/TTO helps you with MEWS Local need for improved handover
Aims & objectives Assess the quality of clinical
information documented for weekend-cover
Design a proforma following RCP guidance
Assess quality before and after the introduction of a proforma
Standards: http://www.rcplondon.ac.uk/resources/clinical-resources/standards-medical-record-keeping/structure-and-content-medical-notes/
http://www.rcplondon.ac.uk/sites/default/files/clinicians-guide-part-2-standards_0.pdf
RCP Headings and definitions for handover documentation Document April 2008
MethodsData was collected in 5 cohorts:
Inclusion criteria:- New admissions from the previous week Monday to Friday
- Cohort 1: Monday 8th – Friday 12th November 2010- Cohort 2 : Monday 15th – Friday 19th November 2010- Cohort 3 :December * data not collected (snow)- Cohort 4 :Monday 3rd–Friday 6th January 2011 AUDIT of INTERVENTION
- Cohort 5 :RE-AUDIT of intervention :COMPLETING THE AUDIT LOOP- Inclusion criteria – all proformas in use- weekend of 7-8 January 2011
Methods Quality of Clinical information documented was assessed Before & After
the introduction of proforma by identifying if the following were noted:
1. active problem/ diagnosis2. background / PMHx3. plan for weekend4. investigations to be reviewed out of hours5. Resus status6. Last MEWS score / not for MEWS7. date of admission8. initial reason for admission9. Date , Team & Clinician
weekend summary proforma
resultsBefore
INTERVENTION
Cohort 1&2
After INTERVENTION
Cohort 5 :7-8/Jan/11
Number of Cases: 26 27
% proformas used: 0 100
Active Problem/Diagnosis noted 66 % 96 %Past Medical Hx noted: 31 % 78 %
Plan for weekend noted: 52 % 96%Resus status noted 0 % 81 %
investigation for weekend review identified 31 % 48 %
Quality of Weekend Handover Before & After the Introduction of a Proforma
0 20 40 60 80 100 120
acute admissions between:
Number of Cases:
Number of proformas used:
% proformas used:
Active Problem/Diagnosis noted
Past Medical Hx noted:
Plan for weekend noted:
Resus status noted
investigation for weekend reviewidentified
clinical information
per
cent
age
Cohort 1+2 average before proforma Cohort 4 - all proformas in use on 7/1/11
resultsCohort 1+2 average
before proformaCohort 3 - after
proforma
acute admissions between:Number of Cases: 26 21
Number of proformas used: 0 11
% proformas used: 0 52%
Active Problem/Diagnosis noted 66% 100%
Past Medical Hx noted: 31% 82%
Plan for weekend noted: 52% 100%
Resus status noted 0% 82%
investigation for weekend review identified 31% 55%
Conclusions Proforma objectively improves documentation
Puts into action RCP best practice for handovers
Encourages re-appraisal of cases
Improves continuity of care between firms
Helps house officers with MEWS speeds up referrals & TTOs
Ideal for new cohort of FY1 in August
Now: can help with this year’s frequent bank holidays
Discussion, feedback & Next Steps Pros Improves patient safety through clear documentation
Cons: some problems with feasibility of filling forms in detail if ward
rounds are busy
AUDIT LOOP COMPLETION & IMPLEMENTATING CHANGE
use feedback to make improvements Approval committee process - Completed + Clinical Governance Committee – for role out August 2011
Improving Out of Hours Patient Safety
a Weekend Handover Proforma
S.Arun FY1Gen. Medicine Jersey General Hospital
