ISQUA18-1196“Hands Off the Patient Until You Know Everything You Need to Know!”

Abstract

Objectives: Failures in the clinical handover process have been identified as a major cause of preventable harm to patients. Historically, handing over critically unwell or injured patients between ED and CICU has been done poorly. There is a documented significant increase in adverse events such as a delay in diagnosis, repeating of tests or procedures or medication errors when a patient is transferred to another unit or treating team. On review of our process we identified a problem worth solving. Our aim was to develop a structured approach to the handover process and to achieve 90% compliance within 2 years. Methods: Staff surveys and focus groups were conducted to identify the barriers and levers of the clinical handover process. Using this data, a standardised patient transfer process incorporating the ISBAR principles was developed. The finalised format included a guideline and a checklist. The process was then tested in a simulated environment by the project team. Further refinement of the guideline and tool post simulation was enabled through video review and reflection of the simulation. An audit tool was developed to evaluate the handover process prior to and post implementation. Using quality improvement methodology we identified our outcome, process and balancing measures. Results: ISBAR/ ABCD approach to handover Pre 25% and post 78% Pre survey and focus groups highlighted that there was little structure to the handover and varied greatly depending on who conducted the handover. Clear team leader during transfer Pre50% and post 82% Based on the surveys and focus groups it was identified that clinicians were often unclear who was leading the handover. Parents invited to comment/ ask questions Pre 50% and post 53% Parent / family engagement in the process was crucial in not only family centred care but also identifying any crucial information that may have been missed or interpreted incorrectly by clinicians. Hands off approach during handover 50% and post 78% A “hands off ” approach is a process that is used in handover of critically unwell or injured children from NSW ambulance and NETS. The “hands off ” approach ensures all staff stop and listen to all aspects of the handover. Interruptions during handover process Pre 37.5% and post 13%. We developed some ground rules that included that no interruptions were to be made during the handover unless the patient's safety was at risk. This has also mitigated the risk of multiple conversations going on at once and all information is shared by the entire team. Average time taken to handover pre 11 mins and post 8 mins 40 sec. By establishing a more concise and efficient process we have reduced the overall time taken Conclusion: Our data has shown a measurable improvement in a number of areas of clinical handover for critically ill or injured children to CICU. Implementation of this guideline and checklist is applicable to all patient transfers in any critical care environment.