Discussion:

The handover tool objectively improved quality of handover documentation.

Combining user involvement via the Junior Doctors Teaching Forum & RCP

guidance helped to develop a clinically useful tool.

Improving the quality of documentation during doctors’ handovers is an important part of achieving quality improvement in patient safety.

Previous practice required improvements for doctors in training to meet GMC Mandatory Patient Safety Requirements and for best practice guidance

to be implemented.

The audit data shows that there was a statistically significant improvement in the quality of clinical information handed over from doctor to doctor

when using the handover tool.

The handover tool delivers improvements in quality of clinical information documentation which can aid out-of-hours clinical decision making and

overall thus enhance quality of care for individuals.

Objectives:

Jersey General Hospital is the sole provider of secondary care for 100,000 Islanders.

Caring for a population of this size poses unique challenges.

The Out-Of-Hours Medical Team is small; staffing levels are reduced by 75% .

The Royal College of Physicians’ Handover Guidance recognises this clinical area’s

potential for risk.

Locally, the need to utilise audit to establish the existing quality of doctors’ handover

documentation was acknowledged.

A handover proforma was introduced. A re-audit assessed its effectiveness at im-

proving quality of documentation.

Addressing Out-of-Hours Handovers in Jersey, Channel Islands:

Implementing Royal College of Physicians Best-practice Guidance for

Handover Documentation Through Audit S. Arun-Castro, T. Arun-Castro, W. Ong, Wessex Deanery.

Method:

A Literature review of doctors handover studies was conducted

GMC Requirements & RCP Guidelines were reviewed

Audit Inclusion Criteria: All Inpatients <120hrs from admission.

Presence of clinical information documented at the point of handover including

“Resus Status” and “Weekend Plan”.

The handover proforma was designed with the co-operation of consultants, regis-

trars and junior doctors via the Jersey Postgraduate Education Committee. In addi-

tion the specific types of clinical information audited were identified using RCP

handover guidance and templates.

Results:

74 medical cases were audited. 38 used a proforma.

98% of cases using a proforma established a specific weekend plan compared to 52%

prior to intervention.

Likewise, most clinical details were better documented. With p values <0.05

Type of Clinical

Information

Percentage of

cases with

documentation

NO PROFORMA

Percentage of

cases with

documentation

PROFORMA

P value

Active Problem or

Diagnosis documented 66% 98%

p<0.05 Past Medical Hx

documented: 31% 80%

p<0.05 Plan for weekend

documented 52% 98%

p<0.05

Resus status 0% 82%

p<0.05

Documentation of

investigations required for weekend review 31% 51.5%

p = 0.08

GMC Trainee Doctor 2011 Mandatory Requirements:

To “have well organised handover arrangements, ensuring continuity of pa-tient care at the start and end of periods of day or night duties every day of the week.”

Policy Outcomes:

The audit has provided the evidence necessary to change hospital policy trust-wide.

Funding has been secured to support its continued use. Trainee teaching time syllabus now includes a patient safety & handover session. The new cohort of trainees will re-audit to establish uptake long term . The tool facilitates the clinical practice in Jersey, enabling the achievement of General Medical Council (GMC) mandatory requirement for doctors’ handovers in training.