Emergency physician intershift handover - can a dINAMO checklist speed it up and improve quality?

Physician intershift handover has been identified as an area of high risk for adverse events, representing a critical step in patient care transition. Due to frequent shift changes and high patient numbers, emergency departments offer an ideal study setting.

At a tertiary care hospital emergency department we aimed to reduce the time needed for patient handover while maintaining or improving quality of information passed between shifts.

Between 31 March and 20 June 2008 we observed intershift handovers in all non-surgical patients at 8 a.m. between nightshift and dayshift. We collected data on handover characteristics and patient demographics. After the usual clinical rounds following each handover, we asked senior physicians about missing or wrong information and possible implications for patient management. From 31 March to 9 May pre-interventional observation took place. On 13 May the dINAMO checklist with five items and a standardised feedback following each handover was introduced. Post-interventional observation lasted until 20 June.

61 handovers totalling 23.4 hours of observation time covered 1011 patients. The intervention using the dINAMO checklist reduced mean handover time by 26% from 99 ± 3.3 to 73 ± 2.8 seconds per individual patient (p <0.0001). This resulted in a reduction of morning handover duration from 30 to 20 minutes. Senior physicians reported insignificant improvement of quality of handover. A significant decline in missing or wrong information from 194 incidents in 496 patients to 78 in 470 patients was recorded.

An intervention consisting of a simple checklist of five items (dINAMO) and an immediate feedback on quality not only contributes to a significant shortening of time needed for physician intershift handover in a university hospital emergency department, but simultaneously helps to improve quality of information and therefore patient management.