Improving out-of-hours surgical patient care

Area of Science:

• Healthcare Quality Improvement
• Patient Safety in Surgery
• Surgical Department Management

Background:

• Patient handover is a critical juncture for patient vulnerability in surgical settings.
• A London teaching hospital's surgical department faced challenges with unstructured handovers, limited clinical information access, and insufficient weekend staffing.
• These issues posed risks to patient safety.

Purpose of the Study:

• To address concerns regarding patient handover and weekend staffing in a surgical department.
• To design and implement a quality improvement program to enhance patient safety.
• To discuss the issues and the implemented solutions.

Main Methods:

• A structured questionnaire identified key factors affecting weekend patient safety.
• Implementation of an electronic handover tool, regular handover meetings, and increased weekend staffing.
• Continuous audit cycle with feedback to team leaders for ongoing assessment and improvement.

Main Results:

• Handover meeting attendance exceeded 80% over three months.
• Electronic handover entries showed progressive improvement, averaging 42.2% to 92.9% across seven criteria.
• Weekend staffing increased by 50%, enabling dedicated care for inpatients and discharge oversight.

Conclusions:

• The quality improvement program resulted in significant and lasting changes to the surgical department's weekend system.
• A more structured and reliable patient handover process was established.
• Effective mechanisms for dynamic performance feedback were created, enhancing ongoing patient safety.