485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Brennan ◽  
D Holroyd
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Team Members ◽  
Surgical Department ◽  
Significant Variability ◽  
Standard Operating ◽  
Handover Process ◽  
Audit Standards ◽  
Standard Operating Protocol

Abstract Introduction The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients. Method Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation. Results The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration. Re-audit demonstrated significant improvements in all domains to > 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document. Conclusions A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.

scholarly journals Standard operating procedure for the management and prevention of post-partum haemorrhage in a public general hospital in rural South India: a quality improvement project

2021 ◽  
Vol 8 (6) ◽  
pp. 2897
Author(s):  
Arkadeep Dhali ◽  
Christopher D'Souza ◽  
B. Rathna Roger
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Operating Procedure ◽  
Assessment Tool ◽  
Post Partum ◽  
Standard Operating Procedure ◽  
Quality Improvement Project ◽  
Maternity Ward ◽  
Improvement Project ◽  
Standard Operating

Background: The Obstetrician stationed in a Public General Hospital noticed that there were no standard guidelines nor any assessment tool for the management of post-partum hemorrhage (PPH). This developed the idea to prepare a standard protocol.Methods: Aiming to ensure prevention and proper management of PPH in the Maternity ward, a team was formed to perform a Quality improvement project (QIP). A Standard operating procedure (SOP) was formulated referring to the National Health Mission (NHM). Outcome indicators were defined. A series of interventions were implemented and assessed using Plan-Do-Study-Act (PDSA) cycles. The findings from the PDSA cycle of a previous intervention were used to implement change in the next intervention. The data was analysed to accept the change or to further modify it.Results: At the end of 3 months, percentage of patients with PPH reduced by 3%, percentage of patients diagnosed with PPH within the 1st hour increased by 50%, percentage of patients with PPH treated appropriately increased by 20% and percentage of patients requiring referral due to PPH decreased by 15%. Thus, at the end of 3 months there was significant improvement in the values of the outcome indicators.Conclusions: In the span of few months, we were able to implement an SOP and bring a significant improvement in the management of PPH in the maternity ward. 

scholarly journals 1250 Introduction of a New Electronic System in Surgery during the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Jacob ◽  
O Chaudhary ◽  
N Darwish ◽  
H Pardoe
Keyword(s):  
Quality Improvement ◽  
Current System ◽  
Electronic System ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Social Distancing ◽  
Surgical Department ◽  
Information Governance ◽  
Ward Rounds ◽  
The Impact

Abstract Aim The ongoing COVID-19 pandemic has impacted all aspects of clinical practice. Preventative measures to avoid spread of the virus has included maintaining social distancing, thus making surgical handovers and ward care particularly challenging. The surgical department at PAH were able to reflect on what improvements could be made to the current system during this time, with a particular focus on efficiency and information governance, while also maintaining social distancing. Due to the advancement in information technology, electronic systems have become widely used throughout the NHS and a quality improvement project was introduced to try and improve our department using an electronic handover Method A quality improvement project was carried out, with questionnaires sent out pre- and post-implementation to evaluate the impact of the new electronic handover. Results Implementation of the electronic handover improved the safety and efficiency of the surgical department, particularly with information governance (p < 0.001), efficiency of ward rounds (p = 0.002) and social distancing. Less doctors were taking lists home (p < 0.001) and fewer doctors needed to return to the MDT room during ward rounds to check key clinical information (p < 0.001). Close to 50% of doctors said that the implementation of an electronic system reduced the need to be in crowded MDT rooms to check patient information. Conclusions There were clear benefits to using an electronic healthcare system both for satisfaction of workers and for patient care. The project used pre-existing IT software that was modified through collaboration with the IT department and is something that will continue to be improved in the future.

EP.TU.304The Role of the Surgical Senior House Officer: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Charlotte Boardman ◽  
Martin Klein ◽  
Michael Saunders
Keyword(s):  
Quality Improvement ◽  
General Surgery ◽  
House Officer ◽  
Quality Improvement Project ◽  
Senior House Officer ◽  
Improvement Project ◽  
Surgical Department ◽  
National Quality ◽  
Training Opportunities

Abstract Aim The role of the surgical Senior House Officer (SHO) is very variable and evidence reports that many surgical SHO posts do not meet national quality standards. SHO is an active training role in which the doctor should be exposed to all aspects of General Surgery to prepare them to become a registrar. However, in a busy surgical department this can be difficult to achieve whilst ensuring that acute inpatient care is not compromised. A quality improvement project was undertaken to increase the quality and quantity of training opportunities available for the surgical SHOs in a district general hospital. Methods All of the SHOs in the general surgery department were asked to complete a survey about their experiences as an SHO. A timetable with personalised allocations to on-call cover, theatre sessions, clinics and ward work was introduced. After one month, further survey data was collected to re-assess. Results Prior to the implementation of the new timetable, the SHOs did not understand their role within the department and had minimal exposure to the elective aspects of General Surgery. One month after implementation, job satisfaction was greatly increased and attendance in clinics and theatres had doubled. Conclusion The implementation of this timetable resulted in a significant improvement in training for the surgical SHOs and clarification of their role within the department. By specifying activities within a formal rota, overcrowding of SHOs in theatre sessions and clinics was avoided and it ensured that all SHOs were provided with equal and adequate training opportunities.

scholarly journals 988 A Quality Improvement Project; Improving the Quality and Safety of Handover During COVID-19

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Chawla ◽  
M Said Noor
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Continuity Of Care ◽  
Quality Improvement Project ◽  
World Health ◽  
Junior Doctors ◽  
Free Text ◽  
Post Intervention ◽  
Improvement Project ◽  
Handover Process

Abstract Aim The World Health Organisation (WHO) positions effective handover, in its top five patient safety solutions. During our District Hospital Trust’s COVID-19 response, an unprecedented reorganisation of all teams occurred. All surgical and medical speciality junior doctors were re-deployed and split into 4 zones to cover the hospital. In this quality improvement project (QIP), we sought to understand our trainees’ thoughts on this new multi-zonal handover process and aimed to identify risk-reduction measures to aid better patient care. Method The opinions of trainees on the new handover system were obtained using an online Likert scale survey. Following the responses, a new morning and night handover proforma was developed. This was used trust-wide and a post-intervention repeat survey was conducted to assess the new changes. Results The primary survey received 31 responses with feedback illustrating mixed effectiveness of the existing handover process. Free text comments highlighted issues surrounding “safety”, “poor organisation”, “poor continuity of care” with one serious incident reported. Post-intervention of a new handover proforma, a repeat online survey received 25 responses. Results were significantly more positive with >84% of responses being in the “strongly agree to agree” category, including for “continuity of care”, “organisation”, and “safety”. Conclusions This QIP illustrates a good example of a low-cost intervention to create a better handover system and aid hospitals during time of crises. For us, it managed to reform the handover process and ultimately improved our patient care. Forthcoming, we would like to create a national best practice guide for effective handover.

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