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

Area of Science:

• Healthcare Management
• Patient Safety
• Clinical Operations

Background:

• Protocols for patient handover from day to hospital at night (H@N) teams were developed.
• A mixed-method study observed four handover protocols over two years in a UK NHS paediatric specialist hospital.

Purpose of the Study:

• To explore the impact of different handover protocols on performance.
• To assess the effectiveness of a new H@N handover protocol in identifying acutely unwell patients.

Main Methods:

• A mixed-method approach including observation, interviews, task analysis, prospective risk assessment, and document/case note review.
• Four handover protocols (baseline, Phases 1, 2, and 3) were observed over two years, with Phases 1, 2, and 3 involving protocol revisions based on staff feedback.

Main Results:

• Significant variations in handover efficiency, duration, and interruptions were noted across protocols.
• Phase 1 and 2 protocols effectively identified patients needing overnight review, but performance on flagging omissions and out-of-hours deteriorations declined in Phase 3.
• Phase 3 showed statistically significant increases in flagging omissions and out-of-hours deteriorations compared to Phases 1 and 2.

Conclusions:

• A well-designed prioritization process in H@N handovers can effectively flag acutely unwell patients.
• The developed protocol proved unsustainable in a complex healthcare setting.
• Conflicting goals within the healthcare system can impede the sustainable implementation of new processes.