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Abstract
Context Every morning handover takes place in our multi-specialty 12 ward 300 bedded children’s hospital. The single hospital at night team handover to 8 different specialty teams. One night junior doctor verbally scrolls down the written handover ward lists, verbalising any event overnight on patients by bed space order.
Problem Hitherto there was no systemic transfer of system information, prioritisation or horizon scanning during handover. Major events overnight such as crash calls and intensive care admissions may not be published if the patient is no longer on the wards.
Assessment of problem and analysis of its causes We identified that the handover could be improved by the introduction of a safety briefing. Key messages were often lost in the handover process due to its complexity. Discussions were held with key stakeholders surrounding current handover arrangements and their views on a proposed safety briefing.
Intervention We implemented a 60 s safety briefing to set the scene at the beginning of handover. The safety briefing covered four key areas (the 4S): Sick, Safety, System and Safeguarding.
Strategy for change Utilising change theorywe initiated the change from the bottom-up, enabling the night junior doctor leading the handover to deliver the safety briefing. Boxes on the typed handover sheet titled ‘safety briefing’ were created to allow recording as a prompt for the oral delivery (Figure). Over one week including weekends (7 handovers) we attended both morning and evening to explain and guide the safety briefing.
An example of the 4S safety briefing at the top handover sheet (Sick, Safety, System, Safeguading). Names have been changed
Measurement of improvement Primary measure was whether it happened every day. A survey was conducted with showed high levels of acceptability from all grades of doctors.
Effects of changes During the week of repeated PDSA cycles (Plan Do Study Act), the delivery became increasingly reliable and focused. Issues picked up included: dosing errors (weight in pounds vs. kilos), misidentification of patient for venepuncture, early identification and resolution of staffing issues.
At the start of implementation hierarchy prevented its use on one occasion, however with early adopter active visible senior support we were able to restart the briefing next day and momentum continued. Since the one-week implementation, it is now embedded and has occurred each morning handover at 6 months.
Lessons learnt We demonstrate that a ground-up approach to introducing change in a short timeframe is possible. Its success came from grassroots support capitalising on their intrinsic motivation to improve patient safety.
Message for others Introducing and sustaining a handover safety briefing was very much welcomed by the ground staff as well as organisation leaders. Secondary gain was culture change where now talking about safety is normal and acceptable as it is the first item on the safety briefing every morning.