A closed audit loop looking at the effectiveness of handovers within a paediatric surgery department

Introduction: Effective handovers are important to ensure safe transfer of patients care. With the European working time directive for doctors in training there has been a move towards full shift rotas which means different groups of staff looking after the same patient. Robust handover mechanisms are needed for patient safety and effective team working. Guidance highlights factors that enable appropriate handover including; being senior led and conveying appropriate information in the SBAR approach. We aimed to assess the effectiveness of handovers within paediatric surgery against local guidance and that provided by the Royal college of Surgeons. Methods: A closed loop audit was performed; initial data was collected prospectively between September 2019 and November 2019 in a Tertiary teaching hospital within the United Kingdom. Two independent assessors gathered data including; timing of handover, team presence, and interruptions. Further team members were blinded to the study. Following data collection and analysis, results were presented at a clinical governance meeting. Recommendations made included: handovers starting on time, a lead should be identified at the start, apologies should be made prior to start time, and a fixed pattern to reduce time of handover. Data was again prospectively collected on randomly selected days between December 2019 and March 2020, to complete the audit cycle. Results: A total of 20 time points were assessed in the first cycle. All handovers were conducted in a fixed location with people aware of start time with access to computer software to view images and results. 17 (85%) handovers were late (range 1-6mins, mean = 3mins). The night team left on time on 9 (45%) days (range = 6-40minutes in duration). On 15 (75%) of the days members of the team were late to handover start time. 10 (75%) of handovers included interruptions. Repeat audit found that 90% of handovers started late (ranging 1-11mins, mean 4.5 mins). The night team left on time 17 (85%) of days, with handover lasting from 15minutes - 30minutes, the average duration was 21minutes. Team members were late on 18 (90%) of the days. Discussion: Shift work relies on effective information transfer which is commonly achieved through handovers. Our study found that all handovers occurred in a set location with access to patient IT systems in line with recommended guidelines. Prior to intervention, handovers were longer in duration, with night teams leaving late regularly. This improved after intervention as more handovers became senior led and information transferred within handovers was prioritised. Within the first audit cycle, handovers regularly began late with team members often arriving late. On repeat audit no improvement was found, indicating that one intervention at a clinical governance meeting is not enough to create change with further efforts being needed. Good handovers ensure patient safety, and when information is missed it can lead to mistakes impacting on morbidity and mortality. Handover is an important part of modern clinical work within the NHS whereby they need to be effective to minimise risk. Key words: Paediatric surgery, handover NOTE: This research was presented by Brooks Lucy (University Hospitals of Leicester, England) at 2nd World Pediatrics Congress held on June 08-09, 2021. For more details visit: https://www.pediatrics-conference.com