Handover Project

Anaesthetic And Intensive Care Handover Practices In The Northern Region: A 24-hour Snapshot 

Effective handover is pivotal in maintaining patient safety [1]. Variability is known to contribute to critical incidents and adverse events [2]. National guidance recognises the necessity of effective handover and suggests best practice [3]. This project, the first endeavour of the recently established trainee network: Intensive Care & Anaesthesia Research Network of North East Trainees (INCARN.NET), aimed to examine handover practice within anaesthesia and critical care in the Northern Deanery.

Methods Over a 24-hour period in February 2014, all on-call trainees in the region were surveyed via telephone regarding their shift handover. Categorical data was analysed using the Chi-squared test.

Results Sixty-six trainees received handovers in a 24-hour period, of which 58 (88%) were surveyed. The remaining 8 were unavailable at the time due to clinical commitments. Designated handover periods were present at the start of all shifts. A variety of methods were used to hand over information (see table 1). Consultant presence was more frequent in critical care handovers compared with obstetrics and anaesthesia (80, 60 and 38% respectively, p=0.01). Seventeen trainees (59%) covered greater than 2 areas whilst on-call for anaesthetics. No formal handover took place for 13% of multiply covered areas. Only 24% of total handovers were formally documented; methods used included a handover book, a computer database and documentation in the patient notes. Handover information was written on paper by 77% of trainees, but in 22% disposal was not in a confidential manner. Median trainee satisfaction with handover practice, on a 5-point numerical rating scale, was 4 (IQR 4-5 [range 3-5]). Suggested improvements included use of handover books or folders for documentation, more structured handovers and designated handover areas, away from interruptions.

Discussion Our survey demonstrates significant variability in methods and occurrence of shift handovers, particularly anaesthetic shifts covering multiple areas. The majority of handovers are face-to-face; this is a superior method of communicating information, serves as an educational tool for case based discussion and aids team building [4]. Handover documentation is contentious and currently performed inconsistently [1,2]. Structured, documented handover for obstetric anaesthesia has been implemented by units in our region, which should be encouraged throughout the specialty for both clinical and medico-legal purposes [5]. We are now in the process of standardising and implementing guidelines in our trust to improve the anaesthetic handover process and documentation.

References

[1] Manser T, Foster S. Effective handover communication: An overview of research and improvement efforts. Best Practice & Research Clinical Anaesthesiology (2011) 25: 181–191

[2] Segall N et al. Can We Make Postoperative Patient Handovers Safer? A Systematic Review of the Literature. Anesthesia & Analgeasia (2012)115:102–15

[3] British Medical Association, National Patient Safety Agency, NHS Modernisation Agency. Safe handover: safe patients. 2005.

[4] Australian Commission on Safety and Quality in Health Care. OSSIE Guide to Clinical Handover Improvement. Sydney 2010.

[5] Bailes I et al. SAFE Handover: An audit of the efficacy of a structured handover tool. International Journal of Obstetric Anesthesia (2011)20, S1-S55

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