Innovation Poster Session
HRT1215 – Innovation Awards
Sydney
11th and 12th Oct 2012
Clinical Handover
Presenter: Ned Douglas
Health Service: Melbourne Health
The Health Roundtable
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KEY PROBLEM

Findings from the “Hospital at Night” project
indicate that shift to shift clinical handover
between junior medical staff (JMS) at
Melbourne Health (MH) occurred in an
inconsistent manner and did not meet best
practice guidelines.

Shift to shift handovers between JMS were
only 52% compliant with Victorian Quality
Council (VQC) criteria.

This had the potential to negatively impact upon
patient safety and continuity of care.
The Health Roundtable
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AIM OF THIS INNOVATION

To improve and standardise shift to shift
handovers between JMS for all general and
specialist medical and surgical units,
emergency department (ED) and intensive care
unit (ICU) at RMH City Campus and Royal
Park Campus.
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BASELINE DATA
2010
Overall Compliance with VQC Criteria by Unit
100%
80%
Root Causes
What does this Mean?
No Melbourne Health
Handover Guidelines
Lack of standardised handover content,
process and documentation across
Melbourne Health:
• No minimum standards regarding
content
• No specified time or place for
handover
• No handover template for
documentation purposes
Competing
Commitments
Lack of protected handover time
potentially resulting in lack of, or
ineffective handover.
JMS perception that
evening handover
time is at the end of
the rostered shift
(usually 5pm)
Poor utilisation of cross-over periods.
Can result in a lack of handover
occurring at all. Much of handover
occurring after rostered handover time.
No Cross-over period
because of rostering
Lack of paid handover time, potentially
resulting in lack of or poor handover.
Decrease in JMS
after Hours
Handover required to multiple units
resulting in less time available for
handover per unit, potentially resulting
in lack of, or ineffective handover
60%
40%
20%
0%
ICU
ED
Spec Surg
Gen Med
Royal Park Gen Surg
Spec Med
Overall Compliance with VQC Criteria by Time
70%
60%
50%
40%
30%
20%
10%
0%
Night
Weekend
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Morning
Evening
4
KEY CHANGES IMPLEMENTED

Focused on Afternoon Handover in Specialty Medicine, the worst performing time
for the worst performing units.



Protected Handover time 1630-1700
Internal, Melbourne Health, handover guidelines were developed

Handover education was given to all parties involved in handover

Standardised documentation in the form of an electronic handover tool was provided

Designated location: ward in specific location

Standardise content (ISBAR) was required
Standardised process was agreed upon by units involved and followed
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KEY CHANGES IMPLEMENTED
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OUTCOMES SO FAR
Pilot – 2011
Medical After Hours 2
Compliance to MH Handover
Guidelines for CONTENT
Sick Patients
New Admits
98%
38%
Identification
100%
Situation
Background
Assessment
Requireme…


Ideally Senior clinician present
68%
14%
Verbal - F2F or telephone
73.81%
Between 1630 and 1700
87%
98%
95%
Documentation template (handwritten) given
to each cover doctor.
Despite compliance with documentation
template there was no process to keep this
information
Therefore, there was still low accountability
for information handed over – an electronic
handover tool has been developed as a
solution
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At least one JMS present
99%
Compliance to MH Handover
Guidelines for
DOCUMENTATION was 98%

Compliance to
MH Handover
Guidelines for PROCESS
58%
Prioritise over other rostered work
68%
Cross over periods in rostering
83%
Handover Forms
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
No Handover Given
Page to say nothing
to handover
Telephone
Handover
F2F Handover:
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OUTCOMES SO FAR
Improvement - 2012
All units
Audit Results By Specialty
100
100.0
93.8
90
81.3
81.3
100
85.0
76.7
80
70
65.6
59.4
60
80
62.5
57.1
50
40
30
20
10
0
ICU
ED
General Specialty General Specialty
Medical Medical Surgical Surgical
MH
70
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78.3
75
70.3
62.5
60.3
60
50
MH
40
VQC
30
20
10
0
VQC
Specialty medical units increased
from 23% to 62.5% (VQC Criteria)
following improvement.
90.4
90
74.3
Adherence (%)
Use (%)
Timing of Handover and Audit
Results
100.0
Morning
Afternoon
Night
Comparison of change of Adherence (%) to VQC Criteria
Measure
Control
Change
Morning
54%
62.5%
+ 8.5%
Afternoon
39%
60.3%
+ 21.3%
Night
58%
70.3%
+ 12.3%
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LESSONS LEARNT



Support from senior clinicians is vital
Clarity around expectations on a very specific process level
helped drive improvement
Where existing processes were adapted, the best compliance
was seen
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