Assess baseline quality and efficiency of paediatric handovers using a new audit tool
Improve paediatric handovers using a safety briefing and the Situation, Background, Assessment, Recommendation (SBAR) structured communication tool
Re-audit the handover after implementing changes.
Methods Morning handovers of paediatric ward patients from night to day teams in September then November 2013 were assessed. The following data were obtained: date, time, interruptions, usefulness of communication for prioritising and managing patients (5-point Likert scale), SBAR use and how well each SBAR component was conveyed (score 0–2 for each component, 0=not conveyed, 1=partly conveyed, 2=well conveyed). To qualify for using SBAR, all components had to be mentioned. Scoring was done by two doctors at every handover and discussed thereafter until reaching consensus. Data were recorded and analysed anonymously. Quality of communication with and without SBAR was compared using the Mann-Whitney-U test.
Interventions included: leading handovers by example, interactive handover teaching sessions, introduction of a safety briefing (as in the new RCPCH Handover Assessment Tool) and incorporating SBAR into handover documentation.
Results Three weekdays (n = 58 patient handovers) were assessed in September 2013. Communication with SBAR (median 4) was significantly more useful than without (median 3, p < 0.001). On re-audit of three weekdays in November 2013 (n = 86 patient handovers), safety briefing use increased from 0% to 100%, SBAR use increased from 58% to 97%, and communication quality scores increased from a median of 4 to 5 (p < 0.001). SBAR components also improved (Figures 1&2). Duration of handovers decreased from 1.07 to 0.94 min per patient, despite an increase in interruptions due to latecomers, digressions and teaching.
Conclusions Our new, real-time audit tool for evaluating SBAR use and quality of handovers allows targeting of areas requiring most improvement. Introducing safety briefing and SBAR improved quality and overall efficiency of communication. Areas for ongoing improvement include conveying assessment and recommendation, and reducing interruptions, for example by having a discussion slot for one interesting case at the end. Further improvement strategies include keeping handover documentation up-to-date in SBAR format, regular handover teaching sessions and maintaining our safety culture with regular multidisciplinary risk meetings.