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Improving paediatric clinical teaching unit handover: A quality improvement project
Samantha G Gerber1, Marina S Yacob1, Michael R Miller2
1Department of Paediatrics, Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.
Insights
Implementing simple strategies significantly improved physician handover processes, reducing interruptions and enhancing participant satisfaction. This quality improvement project aimed to minimize patient harm from communication failures during care transitions.
Area of Science:
- Medical Education
- Patient Safety
- Quality Improvement
Background:
- Effective physician communication during patient handover is critical for safe care.
- Poor handover quality is linked to preventable adverse events in up to 75% of patients.
- Handover-related adverse events were frequently identified in Paediatric Clinical Teaching Unit (CTU) Morbidity and Mortality rounds.
Purpose of the Study:
- To reduce handover-related adverse events.
- To improve participant satisfaction with the handover process.
- To address key contributors to poor handover identified through root cause analysis.
Main Methods:
- A two-phase quality improvement project was conducted at an academic tertiary care pediatric hospital.
- Phase I involved recording adverse events and root cause analysis with residents.
- Phase II implemented targeted strategies and reassessed handover quality and resident perceptions.
Main Results:
- Interventions led to a significant decrease in interruptions and background noise during handover.
- A trend toward reduced adverse events was observed (13 in Phase I vs. 7 in Phase II).
- All residents perceived an improvement in handover quality, with over 83% reporting some to good improvement.
Conclusions:
- Simple, targeted strategies can effectively improve resident handover processes.
- Enhanced communication and reduced interruptions contribute to better patient safety during care transitions.
- The project demonstrated a positive impact on both objective measures and subjective satisfaction with handover.
Background:
Handover is an integral part of patient care and is dependent on effective communication between physicians. Poor quality handover can lead to patient harm, with up to 75% of patients in whom there are handover failures sustaining preventable adverse events. Paediatric Clinical Teaching Unit (CTU) Morbidity and Mortality rounds identified multiple handover-related adverse events. We therefore undertook a quality improvement project to reduce handover-related adverse events and improve participant satisfaction with handover.
Methods:
This project was carried out in two phases at an academic tertiary care paediatric hospital in London, Ontario. Phase I involved recording any adverse events that occurred overnight. A root cause analysis with paediatric residents identified the key contributors to poor handover. Phase II implemented strategies aimed at addressing these contributors. CTU handovers were then observed using the same questionnaires as Phase I. Following Phase II, a questionnaire was sent to all paediatric residents to evaluate their perceived changes in handover.
Interventions:
Designating a handover room, collaborating with nurses to reduce pages during handover, changing pager messages to minimize non-emergent pages during handover, creating a handover template, and providing formal teaching to medical students and residents.
Results:
Implementation of the interventions resulted in a significant decrease in interruptions and background noise. There was a trend toward a reduction in adverse events from 13 in Phase I to 7 in Phase II. All residents felt that handover improved, with 16.7% stating minimal improvement, 61.1% stating some improvement, and 22.2% stating good improvement.
Conclusions:
Results show that the simple strategies implemented improved resident handover.
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