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
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