Aims To assess and improve the quality of paediatric handover, in the context of RCPCH guidance. The framework of choice for an effective handover, as recommended by the World Health Organisation, is ‘SBAR’; Situation, Background, Assessment and Recommendation. SBAR is also promoted within RCPCH guidelines on successful and safe handover. Furthermore, RCPCH advocate the discussion of unit management, workload, and patient safety at each handover meeting.
Method A proforma was developed, drawing on the RCPCH handover assessment tool, in order to assess handovers. Data collected focused on structure of handover (SBAR), unit management (staffing and bed status) and workload (expected patients and outpatient tasks). Primary intervention, made after baseline measurement, involved education on RCPCH handover guidance. Following data collection at 2 months, a second stage of intervention involved further education and the optimisation of ‘handover sheets’, seeing the addition of visual prompts and structural changes. A final audit period followed at 10 months, to assess changes in practice.
Results Data analysis comparing changes in practice revealed an improvement in SBAR use from 66% (n=157) to 80% (n=123) of patients handed over. Of handovers assessed (n=34 vs. n=25), discussion of patient safety increased across all three domains; high risk (27% vs. 60%), isolation (15% vs. 20%) and safeguarding (27% vs. 72%). Discussion of unit management also increased or remained stable across all three domains; medical staffing (38% vs. 60%), nursing staffing (12% vs. 12%) and bed status (15% vs. 32%). There were minor reductions in the discussion of workload; discharges (67% vs. 64%), expected from GP (74% vs. 72%) and expected from A and E (88% vs. 80%). Similarly there were reductions in the presence of consultants (94% vs. 84%) and nursing staff (44% vs. 32%), while registrar presence remained at 100%. There were no patient safety incidents involving handover before or after intervention.
Conclusion Education of team members and the optimisation of handover paperwork can help to improve the quality of paediatric handover, especially with respect to ‘SBAR’ use and patient safety. We believe this approach could be adopted across other hospital departments.
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