107 Handover and communication

Introduction Handover is a dangerous time in a patient’s journey. Sub-optimal communication can lead to confusion, ambiguity, delays in treatment, medication errors and foster a culture of a lack of accountability Aim An electronic handover system (e-handover) was developed with the aim of enhancing communication and improving patient safety through creating an electronic, auditable trail of all handover between doctors and nurses. Method Following stakeholder engagement (including patients), bespoke e-handover software was designed “in-house” that intelligently links with other trust electronic databases used for documenting in patient notes, admitting, referring and discharging patients. Clinicians input patient tasks to be completed (via SBAR system or equivalent) into e-handover both in hours and out of hours. Handovers are triaged and delegated to appropriate “on call” clinicians who have been provided with tablets that can access e-handover remotely. Implementation Following a successful pilot, it has rolled out to all 48 level one wards in the trust with over 1,000 staff members trained. It has since been expanded to include communication with pharmacists. Results Compared with the previous system of handover, the quality of SBAR style handover has improved by over 60% and the percent of illegible handovers has fallen from 9.3% to 0%. The documented names of staff uploading and signing off tasks have increased from 33.5% and 32.1% respectively to 100%, and the documented time that jobs have been completed has improved from 0% to 89.4%. The volume of jobs on e-handover has also fallen by 42% compared with the previous “red book” system, allowing staff more time to focus on unwell patients and patient flow. 92% of staff (n=81) feel that e-handover is user friendly and 91% would recommend it. Importantly, 71% feel that handovers are safer and 61% feel that patient safety has improved as a result of e-handover. The mean number of cardiac arrests as calculated by t-test has also fallen since introduction of e-handover (p=0.032), although causality cannot be determined due to other electronic systems for sepsis and recording resuscitation status having also been introduced on a similar timescale. Conclusion E-handover is a user friendly and effective method to improve the quality and accountability of handover, improving patient safety and is easily scalable throughout the whole NHS.