Making the handover work in practice

Annabel Morris has recently joined the national Hospital at Night (H@N) team from the human resources department at St. George’s Hospital in south London, where she was the medical HR manager. Annabel spent a night with the St George’s night team and gives Calling Time her first hand view on the experience of working with H@N at night.

‘While we were working on the rotas I always planned to come and see the H@N team in action but things got in the way. When I took on this new role I decided to do a shadowing exercise and going back to St George’s was ideal.’

Annabel shadowed Yvonne Leong, one of the H@N co-ordinators to understand the role and its impact as well as witnessing the night handover.

Annabel met David Gray, one of the senior nurses who has been working in the H@N team since it began last year and he briefed her on the workings of the team. The H@N team at St George’s consists of the co-ordinator, two night nurse practitioners, two SpRs, three SHOs and two F1s. The coordinators are senior nurses and the coordinating is about 40% of their job as they rotate through the team roles to gain a wide range of experience. The coordinators come from various backgrounds including A&E and ITU and the key practical skills they need are advanced life support and patient assessment as well as cannulation and being able to verify death.

After this Annabel met Yvonne Leong. Yvonne is a nurse who has being doing the H@N coordinator role for about four months. Yvonne is constantly learning new skills and recently finished a critical care module which makes her well suited for the coordinator role.

The handover was attended by the outgoing medical teams, the H@N team and the bed manager. Multidisciplinary handover is key to the success of a H@N project and works much better than just doctor to doctor or nurse to nurse handover. The handover started with Yvonne handing out printouts of the H@N system to everyone. This is the list of patients and jobs that had been put on the electronic system earlier by the outgoing medical staff.

The handover began with the medical patients being handed over but then this was interrupted by a trauma call and all the surgeons had to rush off, handing over the surgery patients quickly. The handover resumed and the night medical SpR took details of the sickest patients she needed to see. The team had an interesting discussion about one of the sickest patients in A&E and the benefits of having the right people together to do this was clear and showed how important this handover was. Then more jobs were shared out and the night team started their work.

Yvonne started by giving a tour of the wards to see if they had any patients that needed her team’s attention particularly if they had been given an EWS (Early Warning Score). All the while Yvonne’s bleeper was going off and she was sending off various members of the team to different wards.

This system of working allows the ward staff to be supported and for the patients to get the most effective care at night. When Yvonne got a bleep from a ward nurse she was able to give immediate reassurance and advice. She could instruct them to do appropriate tests and then tell them when a doctor or night nurse practitioner would be on their way.

The H@N team approach has really had a positive effect on the junior doctors working lives. It means that the doctors are not bleeped unnecessarily and when they see a patient it is really because they need a doctor. Yvonne said she used to see house officers in tears all the time struggling under the pressure of the work at night. Now she said this never happens as they work together as a team.

Multiprofessional handover is key to an effective H@N team, and the role of nurse coordinators is crucial to an effective team so competencies for this role are being developed by Staffordshire University. The second phase of this work will be completed by end of the autumn and will be made available on the H@N pages of the healthcare workforce portal at www.hospitalatnight.nhs.uk