Medical Handover at Russells Hall

Dr Manish Pagaria- Consultant Respiratory

Physician

Dr Luke Pickup – Cardiology ST3

Sister Rosalind Anslow – Critical Care Outreach

Dr Hassan Paraiso – Consultant Acute Physician,

CD Urgent Care

Medical Handover

• The NHS is moving away from personal continuity to system continuity.1

• Patient safety relies on high quality information handover.1

• “Formal, robust structured handover” have been identified as a key

features to improving AMU safety and efficency.2

• BMA state “Good handover does not happen by chance”.3

– shifts must coordinate.

– adequate time must be allowed.

– handover should have clear leadership.

– adequate information technology support must be provided.

1. Royal College of Physicians (2011) Acute Care Tool Kit Handover1. RCP. London 2. Royal College of Physicians (2016)Enabling the medical registrar on take RCP West Midlands pilot: final report. RCP. London. 3. BMA (2004)BMA Safe handover: safe patients Guidance on clinical handover for clinicians and managers. BMA Junior Doctors

Committee. London

Russells Hall Hospital

• Russell’s hall is a 722 bed district general hospital.

• Part of the Dudley Group NHS Foundation Trust providing services to Dudley, significant parts of the Sandwell.

• Admissions 2016/2017 – Acute medical Unit 18646

– Ambulatory Emergency Care 9136

– Short Stay ward 5588

■ Significant numbers of admission through AMU –high quality handover to facilitate patient care and experience essential.

AMU Handover

• Location

– Situated in site coordinator office.

• Timing

– 30 minutes at the beginning and end of the medical SpR shift

• Team members

– Acute Medical Consultant

– SpR (AMU/Ward) SHO’s/FY1

– Critical Care Outreach team.

– Site coordinators/senior nurses.

• IT

– Access to clinical portal to assess investigations and imaging

as part of handover process. Nervecenter.

AMU Handover

• 10.00AM HANDOVER

– Consultant coordinates.

– Discussion of patients from the acute take and wards.

– MET calls reviewed.

– Personnel and specific roles established for forthcoming shift.

– Identification of potential issues.

• Staffing, capacity, status of hospital reviewed.

• 22.00 Handover – same format as morning – SpR coordinates.

Information Technology

• “The use of a well-designed electronic handover system can help to reduce the risk of communication failure across shifts.”1

• Nervecentre

– Facilitates continuous handover between shifts out of hours.

– Screening of tasks by senior nursing staff to increase efficiency.

– Eliminates the need for paper handover – safer permanent record of jobs allocated.

– Effective audit tool for continued improvement of system

1. Choudhury A, Shah S, Selvaraj E, Haines R, Kader P, Thompson S, Mazhar K, Reddiar R, Saha S, Johns R, Alcolado J (2014) Medical handovers across shifts within a five-day-working model: results from an electronic handover system in an acute NHS trust. Future Hospital Journal Vol.1 (2) PP.88-97

Is there time defined for multi- professional handover within current working practice?

Yes

Are there checklists in place for the handover process? No. To be introduced

Is there a standardised proforma for communicating the handover? Yes achieved via nervecentre

Is the process of handover included in training/induction? Nervecentre training

Have any serious untoward or critical incidents been attributed, wholly or partly, to poor communication/handover?

No

Is the system of handover audited? No – process currently underway to establish audit process

Is change needed in our local

practice?

Critical Care Service.

• Defined as “a multidisciplinary organisational approach to ensure, safe ensure. Safe equitable and quality care for all acutely unwell critically ill and recovering patients irrespective of location or pathway”. National Outreach Forum 2012.

• “Outreach should be a collaboration and partnership between critical care services and other departments to ensure a continuum of care for patients”.

• Team approach for improved Communication and Care

Critical Care Outreach

• Critical Care Outreach is 24/7.

• One Nurse each 12 hour shift.

• Attend and part of Hospital Medical

Emergency Team, for all M.E.T. calls.

• Currently using RED flags for MET calls,

changing to NEWS.

• All Outreach staff A.L.S. trained.

Outreach at Medical

Handover.

• Meet the Team.

• Handover the M.E.T. patients if they have

had further follow-up, esp. those patients

not within Medicine.

• Inform group of Acutely unwell patients

outside Medicine, with Medical problems.

Benefits to Outreach

• Builds good relationship with Medical Colleagues, esp for referrral.

• Names to Faces.

• Meeting the staff prior to M.E.T. call.

• Discuss patients of concern to us.

• Being aware of potential patients for Outreach.

• Better and safer patient care.

Case 52 year female, Background of COPD, TB, osteoporosis Alerted into resus with SOB. Unable to speak in full sentences. Deteriorating gases since arrival despite treatment

Initial gases on 2l oxygen via NC

pH 7.21

pCO2 7.85

pO2 9.75

Bicarb 23

Base Excess -5.5

Case NIV - 5 litres of Oxygen

Resp. rate 42

HR 152

SaO2 85%

BP 138/86

pH 7.18

pCO2 7.39

pO2 8.832

Bicarb 20.5

BE -8.3

Case

Case

NIV 5litres of Oxygen

Resp. rate 29

Pulse 90

SaO2 100

pH 7.49

PCO2 3.37

PO2 11.6

Bicarb 19.2

BE -2.4

Benefits of a good handover

• Reduced mistakes

• Improved continuity of

care

• Decreased repetition

• Increased patient

satisfaction

• Education

• Clear and

accountable

communication

• Stress reduction

• Highlight concerns

from previous and / or

oncoming shifts

• Improve

communication

Continuity of information

Exchange sufficient information

• Clinically unstable patients

• Brief staff on concerns from previous shifts

• Concerns for new shift

• Tasks to be completed

Action must be taken • Review unstable patients

• Prioritise tasks • Plans for further care

Tasks

Weekdays Weekends

Response times

Incidents

Clinical Non-clinical Falls

Conclusion

• The formalized handover processes in place complies with

current BMA guidance and the Acute Care Tool Kit from the Royal

College of Physicians.

• Medical SpR’s in the trust feel that handover is safe and effective.

• The Nervecentre platform enables safe secure exchange of

information among staff – particularly at weekends and provides

valuable data to enable capacity- demand matching

• Plans for Auditing of the Handover process are currently being

developed.

Thank you for listening