Improving Surgical Handover:

Has using a word-processed document improved the quality of

general surgical handover?

Completed audit cycle

Undertaken at Conquest Hospital, East Sussex Healthcare Trust

Sara Khoyratty, CT1

“Your team were on-call yesterday, here’s your list….”

Standards

RCS Safe Handover Guidance

Audit questions

Were we documenting and, therefore, reliably handing over this minimum amount of data with paper handover sheets?

What proportion of handover sheets were retained by the department as evidence of productivity?

Method

AUDIT: 4 months of paper handover sheets– Organised into months April-July– Data collected

• Per patient• Per list• Per month

RE-AUDIT: 4 months of word processed handover sheets– Organised into months September - December– Data collected and analysed as above

Audit Conclusion

• Keeping a copy of handover lists was very low, ranging from 14% to 65%– Is there a better way of storing this information?

• Basic information should be 100%• Clinical detail needs to be improved – only 40-

60% of patients have a plan or pending investigations handed over– More space– Educate doctors

Changes implemented• Highlighted problems to FY1s and SHOs in

Surgery and Orthopaedics• Explained new system available on ward

computers • Encouraged to be as thorough as possible• Easy access to document templates • Explained where to save documents in organised

system• Encouraged to feedback suggestions or problems

Changes implemented

Results: patient load

Month Patients per month

April 75

May 111

June 76

July 57

Month Patients per month

Sept 118

Oct 137

Nov 137

Dec 126

Paper list: Word processed list:

Results: number of lists retained

MonthNo. of lists retained

(%age retention)

April 42%

May 65%

June 14%

July 26%

MonthNo. of lists retained

(%age retention)

Sept 87%

Oct 77%

Nov 87%

Dec 94%

Paper list: Word processed list:

Results: named on call consultant

Month Recorded on-call consultant

April 42%

May 65%

June 14%

July 26%

Month Recorded on-call consultant

Sept 63%

Oct 65%

Nov 80%

Dec 84%

Paper list: Word processed list:

Results: patient data set completeness

Month Average completeness of patient data set (range)

April 68.1%(50.0% – 77.8%)

May 68.3%(50.5% - 88.9%)

June 74.9%(65.6% - 88.9%)

July 68.5%(54.6% - 79.8%)

Month Average completeness of patient data set (range)

Sept75.2%

(52.8% - 97.2%)

Oct80.5%

(63.2% - 91.1%)

Nov85.0%

(72.2% - 94.4%)

Dec78.0%

(69.4% - 100.0%)

Paper list: Word processed list:

Results: basic information

InformationRange of completeness: basic information

Name 99% - 100%

Patient number 82% - 100%

DoB/Age 84% - 92%

Location 89% - 98%

InformationRange of completeness: basic information

Name 100%

Patient number 93% - 99%

DoB/Age 73% - 88%

Location 97% - 100%

Paper list: Word processed list:

Results: clinical information

Information Average completeness of clinical patient data

Diagnosis 88% - 96%

Results 51% - 64%

Pending 39% - 61%

Plan 50% - 64%

Stability 2% - 9%

Paper list: Word processed list:

Information Average completeness of clinical patient data

Diagnosis 97% - 100%

Results 62% - 88%

Pending 69% - 85%

Plan 78% - 96%

Stability 6% - 15%

Comparison

What did we improve?• Number of lists saved• Overall amount of data recorded per patient &

per list• Name, location and X numbers recorded• Diagnosis, results, pending and plan recorded

Overall satisfaction and non-measured improvements, e.g. name of SpR/FY1 on call

Comparison

What did we fail to significantly improve or worsen?

• Stability of the patients

• Recording the named consultant on-call

Critique

Statistical comparison difficult as percentages skewed by disproportionate data

Verbal handover just as important

Some data was less consistently handed over

Further changes

Microsoft Access database to ensure minimum dataset entry and accurate records.

Have a tick-box system to denote stability, e.g.:

Stability ✓

Stable

Urgent

Critical

Further audit

Implement these changes and re-audit

Audit verbal handover for e.g. 1 week: RCS guidance document

Data collection for 1 year

Thank you!