Greater accountability in nursing handover

Nursing handover exemplifies both the nurse’s professional ethics and the profession’s integrity. The article by Yetti et al. acknowledges the critical role of structure and process in handover implementation. At the same time, they emphasised the fundamental necessity to establish and update handover guidelines. I assert that effective patient handover practices do not simply happen; instead, nurses require pertinent educational support. It is also pivotal to develop greater professional accountability throughout the handover process. The responsibility for ensuring consistent handover quality should be shared between nurse managers and those who do the actual handover practices.

“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

Introduction: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. Methods: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. Results: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). Conclusions: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

920 Improving the Management of Post-Operative Hypocalcaemia In Thyroid Surgery

Aim Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2] due to the removal of the parathyroid glands. This quality improvement (QI) project was undertaken in a large Ear, Nose and Throat department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method A baseline audit was conducted to determine initial guideline compliance. The QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

1503 Review of Electronic Theatre Coding System & Documentation of Neurosurgical Activity

Introduction It was noticed that the current electronic theatre coding system was limited in its reflection of departmental theatre activity and discrepancies in discharge letters compared to the actual operations performed. To prevent this from recurring, a standardised neurosurgical operation note was developed, and an audit of the electronic coding system was undertaken to see if the correct operation matched that of the code listed. Method A 6-month retrospective analysis from March to September 2020 was completed using the electronic theatre coding system, patients’ electronic records and the patient handover list. Results 232 operations performed and only 10.3% of procedures were correctly coded by the current coding system. 11 operations were not on the theatre system although performed in theatres. The current system only coded for 82 procedures and did not show the full range of operations. There was wide variety of operation notes and only 185 operation notes were found on the patients’ electronic record. Frequently the procedure was not clearly identified so juniors relied on the inaccurate electronic code on the theatre list for the patients’ operation hence explaining the problem identified in discharge letters. Conclusions A new coding list for the electronic theatre system was created with 228 procedures divided into correct subcategories. A standardised template for operation notes was also developed and implemented so that full neurosurgical departmental activity is reflected, and accurate discharge letters are completed so that complete data collection can be done for audit purposes.

37 Improving the Management of Post-Operative Hypocalcaemia in Thyroid Surgery

Introduction Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2]. This quality improvement (QI) project was undertaken in a large ENT department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method Following a baseline audit the QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

Patient handover in a European border region: Cross-sectional survey study among healthcare workers to explore the status quo, potential risks, and solutions

Introduction While the popularity of international care is rising, the complexity of international care compromises patient safety. To identify risks and propose solutions to improve international care, this study explores experiences of healthcare workers with international handovers in a European border region. Methods A cross-sectional survey design was used to reach out to 3000 healthcare workers, working for hospitals or emergency services in three neighboring countries in the Meuse-Rhine Euregion. In total, 846 healthcare workers completed the survey with 35 closed- and open-ended questions about experiences with international patient handover. Results One-third of respondents had been involved in international handover in the previous month. The handovers occurred in planned and acute care settings and were supported by numerous, yet varying standardized procedures. Healthcare workers were trained for this in some, but not all settings. Respondents mentioned 408 risks and proposed 373 solutions, which were inductively analyzed. Six identified themes classify the level on which risks and accompanying solutions can be found: awareness, professional competencies, communication between professionals, loss of information, facilities and support, and organizational structure. Discussion This study gives insight in international patient handovers in a European border region. Among the biggest risks experienced are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing roles and responsibilities of peers working across the border. Standardization of procedures, harmonization of systems, and the possibility for healthcare workers to get to know each other will contribute to reach common ground and move towards optimized and patient-safer cross-border care.

Assessment of Healthcare Practitioners’ Insight into the Handover of Patients and its Implications for the Safety of Patients

Inadequate and Indiscernible interpersonal communication between healthcare professionals or groups of professionals is a main causal factor in errors and procedural mistakes in medical practice, and this undermines the safety of patients. The study assessed healthcare providers’ insight into the handover of patients and how this impacts patient safety. A cross-sectional survey was utilized with a sample size of 400, equally divided between nurses and doctors. A well-structured questionnaire was used to elicit the required information. The data collected were analyzed using SPSS 20.0 statistical package. The study revealed that the majority of the respondents had no formal training on patient handover (56.3% vs. 43.7%). Respondents were aware that ineffective communication at handover impacts negatively on patient safety. The traditional method of handover is practiced and the most employed type (77%) and method (54%) of communication is the combined written verbal method. The obstacles to effective communication at handover were time constraints, excess workload, fatigue, and distraction. It was concluded that the insight of healthcare providers about handover and its impact on patient handover is passable and it can be improved upon by including handover in the training curriculum of nursing/medical students, regular refresher courses for practicing nurses/doctors to equip them with the skills that will advance both the content and communication at handover.