International Journal of Healthcare Simulation

Background:

During a single patient journey from admission to hospital discharge, multiple clinical handovers may occur between health professionals from different specialist inpatient teams and between staff at shift changes. Each handover carries a degree of risk for the patient. It is well recognized that poor communication during handovers has resulted in a significant proportion of preventable deaths ^[1]. The World Health Organisation (WHO) has therefore included clinical handover in the 2020 Global Patient Safety Action Plan as one of the key areas of patient care that requires robust processes and policy to ensure and improve patient safety ^[2]. Although handover involves risk, it is a vital part of patient care. It is often the primary source of information for health professionals taking over patient care. However, handover in resus could often feel stressful and chaotic with multiple distractions and variability in the information conveyed. It was also apparent that staff from both ED and SAS were not satisfied with the handover process. During debrief sessions, handover was often mentioned as an area of practice that required change.

Aims:

The aim of our quality improvement (QI) project was to improve the handover process between Scottish Ambulance Service (SAS) staff and Emergency Department (ED) staff for critically unwell and injured patients arriving into resus. In addition, we aimed to improve communication and staff satisfaction with the handover process.

Methods:

By utilizing QI tools such as the model for improvement, process mapping and driver diagrams, change ideas were identified and trialled using inter-professional simulation as part of PDSA (Plan, Do, Study, Act) cycles. This project involved engagement with ED and SAS staff members via online surveys, simulation sessions and staff education.

Results:

We increased staff satisfaction with the handover process from 24% to 88% and no adverse events relating to our changes were reported.

Implication for practice:

From the information gathered during PDSA cycles, a new standard operating procedure (SOP) for handover in resus was created.