Supporting effective handover in an acute trust

How a major London acute hospital has used a simple IT tool to support multi team handover.

The use of multidisciplinary teams on rotas and the Hospital at Night model is a key way of supporting the 48 hour week but there is a need to have clear handover procedures in place to ensure continuity of patient care. In a major acute trust with multiple teams working across specialties this is even more important.

St George’s Healthcare is a large teaching hospital in London based predominantly around a single site of nearly 1,000 beds. The trust has performed well against the Working Time Directive by embracing new rotas and ways of working using the flexibility in staffing numbers that a large teaching hospital can provide. A key element the trust wanted to build in was a handover system that supported both staff and patients.

The challenge

In the past, with junior staff working long hours on call, handover was carried out informally as the same physician would usually follow a patient over the course of several days. With the trust adopting new shift rotas and the Hospital at Night approach, three different teams (day, evening and night) look after patients in any one area of the hospital and a new approach to handover was essential. St George’s has nine separate general medical teams alone so a solution that could be adopted across the hospital was required.

“We were inspired by attempts we had seen at other trusts to adopt an IT based aid to handover”, says Dr Adrian Draper, consultant physician, “We were lucky in that our patient record system is good and our IT infrastructure is up to date. We knew it would provide an audit trail that paper based systems just couldn’t guarantee across so many teams.” When it was decided to introduce the Hospital at Night team system, work on an effective handover system was built in to the planning stages. The junior doctors were consulted on what they needed in order to make handover work for them - a simple yet effective system for ensuring handover was needed at St Georges and the answer quickly became clear.

Making the ideas into a practical system

The trusts IT team were then asked to make the medical teams ideas work. The solution is a relatively simple, easy to use feature that is based as part of the Electronic Patient Record (EPR) system within internet explorer. In simple terms, a Hospital at Night button was created on the EPR system - the section is accessed by a single click by any member of staff who can simply add notes that the next team on shift need to know about patients. “The system runs from the EPR and is very easy to access and use,” explains Dr Draper, “It’s simple to add a note and you can be confident that the next team will get that message as it’s there in black and white on the screen.” Those notes are then available as a list and is then permanently available to any team member who logs in and can be printed off to give an audit based trail of messages and handover notes.

Reviewing the changes

The system has worked well and has become part of the Hospital at Night process at St George’s. The system has been continually developed by the staff involved as it has been introduced and is seen as being much better than any paper based system. One of the challenges is that the EPR system doesn’t yet take in live admissions data for emergency admissions but that would have been a challenge for any paper or IT based system.

As Dr Draper explains; “As a doctor, you like to be able to check on a patient regularly and know when they might need help. This gives us a list of potential problems and helps ensure that you know which patients to see and why. It gives the staff and patients security.”