This project was intended to observe the handover of trauma and orthopaedic patients at a
      district general hospital in the UK. Following the implementation of a standard operating
      protocol, the handover of patient information improved including neck of femur fracture
      patients significantly. The study can therefore be utilised by other similarly structured
      departments to improve the handover process, thereby improving patient safety.

A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

Neck of Femur Fracture

Fractures, Bone

Orthopedic Disorder

Poor handover and inadequate transmission of clinical information between shifts can result
      in patient harm. This study was designed to evaluate the impact of implementing a handover
      protocol on the quality of information exchanged in the trauma handover meetings in a UK
      hospital.

      A prospective single centre observational study was performed at an acute NHS trust, using
      the Plan-Do-Study-Act (PDSA) methodology. Ten consecutive weekday trauma meetings, involving
      43 patients, were observed to identify poor practices in handover. This data was used in
      conjunction with the Royal College of Surgeon's recommendations for effective handover (2007)
      to create a standard operating protocol (SOP). Following the implementation of the SOP, a
      further 8 consecutive weekday trauma meetings, involving a further 47 patients, were
      observed. The data collection was performed by 5 trained independent observers. The data was
      analysed using t test for quantitative variables and chi-square or Fisher's exact tests for
      categorical variables.

Standard Operating Protocol

A calculation was performed of how many patients had information handed over to the day staff. This included if a patient's past medical history, investigation results, plan, consent status, mark status and starvation status was handed over either written or verbally. This was expressed as a percentage.

A calculation was performed of how many patients with NOF fractures had information handed over. This included the patient's age, mechanism of injury, past medical history, investigation results, plan, consent status, mark status, starvation status, scoring system calculation and discussion with next of kin regarding resuscitation status. For each of these domains for each patient, if the information was handed over, this was noted and was expressed as a percentage.

From the handover meetings that were observed, it was noted whether 'unwell' patients from the ward had been handed over. This was expressed as a percentage from all the meetings that were observed.

Foundation Year 2 Doctor

The verbal and written handover of these patients was observed. This included 146 general orthopaedic admissions patients and 43 trauma patients. All patient data was anonymised.

The verbal and written handover of these patients was observed after the introduction of the intervention. This included 81 general orthopaedic admissions patients and 47 trauma patients. All patient data was anonymised.

A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

About this trial

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Type

Placebo

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Not accepting

Trial Timing

What is this trial about?

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