Implementing electronic handover: interventions to improve efficiency, safety and sustainability

Area of Science:

• Healthcare Informatics
• Clinical Workflow Optimization
• Patient Safety Research

Background:

• Effective patient handovers are vital for safe and efficient healthcare delivery.
• Electronic handover tools aim to standardize information exchange but face implementation challenges.
• Previous attempts at electronic handover tool adoption in tertiary hospitals were hindered by low end-user compliance and buy-in.

Purpose of the Study:

• To address challenges in implementing a new electronic handover tool integrated with electronic medical records (EMRs) at Singapore General Hospital (SGH).
• To improve compliance and adherence to safety rules for an electronic handover system.
• To ensure the safe and sustained use of the electronic handover tool.

Main Methods:

• A quality improvement initiative employed rapid Plan-Do-Study-Act (PDSA) cycles involving end-users and stakeholders.
• Multi-faceted interventions, including media and online software solutions, were developed to enhance compliance.
• Key outcome measures included the percentage of unacknowledged handovers and assessments of doctors' knowledge and perceptions.

Main Results:

• The study successfully reduced the percentage of unacknowledged daily handovers through iterative PDSA cycles.
• Interventions led to improved doctor compliance with electronic handover procedures.
• Doctors showed enhanced understanding of safety rules and a more positive perception of the electronic handover tool.

Conclusions:

• Successful implementation of electronic handover tools necessitates close collaboration between end-users and senior leadership.
• A hybrid 'bottom-up' and 'top-down' strategy, coupled with continuous process evaluation, is essential for long-term sustainability.
• Electronic handover tools can effectively complement clinical practice when implemented thoughtfully.