Creating a safe, reliable hospital at night handover: a case study in implementation science

Area of Science:

• Healthcare management
• Patient safety
• Clinical workflow optimization

Background:

• Developing effective patient handover protocols is crucial for continuity of care, especially in hospital at night (H@N) settings.
• Existing handover processes often face challenges impacting patient safety and care efficiency.

Purpose of the Study:

• To develop and evaluate novel handover protocols for hospital at night (H@N) teams.
• To assess the impact of different handover protocols on patient care quality and safety.

Main Methods:

• A mixed-method study was conducted over two years in a UK NHS pediatric specialist hospital.
• Four handover protocols were observed and analyzed using methods including direct observation, interviews, task analysis, risk assessment, and document review.
• Interventions involved introducing and iteratively refining H@N handover protocols based on staff feedback.

Main Results:

• Significant variations in handover efficiency, duration, and interruptions were observed across protocols.
• Phase 1 and 2 protocols effectively identified patients requiring overnight review, reducing omissions and out-of-hours deteriorations.
• Protocol performance, including patient flagging and efficiency, declined in Phase 3, indicating a loss of effectiveness.

Conclusions:

• A structured prioritization process in H@N handovers can effectively identify acutely ill patients.
• The developed handover protocol was ultimately unsustainable for long-term implementation.
• Conflicting goals within complex healthcare systems can impede the sustainable adoption of new clinical processes.