PRACTICAL PROBLEMSSPECIALITY FEATURE
solutions that are acceptable, redesigned our process, and
robust and demonstrably introduced it through the help
Y better than before is not an of key clinical champions,
easy task, so we enlisted presentations and by
LIBRAR
help from three different providing a laminated version
PHOTO
sources. To change and of the protocol at each bed.
evaluate our handovers we We were able to demonstrate
■ enlisted expertise reductions in information
from civil aviation errors, equipment problems
THOMAS/SCIENCE
■ discussed complex and time taken. Perhaps
technical and team most importantly – and the
MARK
dynamics with the reason why this process POCO_BW/ISTOCKPHOTO.COM
racing lead at the Ferrari has been sustained – is that
Formula 1 team it dramatically enhanced
■ combined our knowledge trust between care teams. is perhaps most important a human factors research
of human factors with about improving the quality clinician for more than
that of clinical experts.
Thinking outside
of care and our own working a decade. He led an
The table details the the box lives is to continually examine internationally recognised
lessons we learned and how we deliver it. Changing aviation security research
shows how we translated Our work has used analogies an existing process is not team, before researching
their practices and applied and lessons from other high- easy, but just focusing errors in surgery at Great
them to healthcare. risk industries to improve on one or two things in Ormond Street Hospital.
By using the principles handovers by understanding your handovers might He now works in the
in the table in our own the relationship between make a lot of difference to Department of Surgery
handovers from surgery people, tasks, technology you and your patients. in Oxford, building the
to intensive care, we and the environment. What Dr Catchpole has been QRSTU research group.
Handover principles Lessons in action
Leadership Ensure that it is clear who is in charge and whom the responsibility of care is being transferred from and to.
Decide who is responsible for what in a handover, eg, it should be someone’s job to make sure that patient notes are
Task allocation
available at the right time.
Discuss what you expect to happen to this patient in the next phase of care. What should their stability be? What
Predicting and planning
treatments should they be getting?
Discipline and When under time pressure, develop explicit communication strategies that will facilitate fast accurate transfer (SBAR);
composure minimise and manage interruptions and distractions.
Don’t just rely on a single handover for all the information; successive updates over longer periods of time (eg, the night
Regular briefings before surgery, the morning of surgery, and post-surgery) can ensure that missed information is picked up or important
themes are identified.
This is the ability to know what is happening, understand what that means, and predict the implications for the future.
Maintain situation
If you recognise you aren’t able to predict what is going to happen, your awareness has started to become degraded.
awareness
Standing back from the situation may aid this.
These ease the reliance on memory and can be used as a prompt to ensure all details of a task have been covered. They
are well established in most other high-risk industries, and if designed in a user-friendly way, will make most jobs much
Use a checklist
easier. Our information transfer checklist became the receiving note for admission into ICU, saving time (and a lot of
writing) as well.
Use technology where But technology alone cannot remove human errors, eg, PDAs are a great idea for transferring care information, but they
possible can easily run out of batteries or become misplaced.
Regularly review Make sure that you measure the improvements that you make, eg, audit notes, time how long handovers take and talk
handover processes to staff and patients.
SALAHOR/ISTOCKPHOTO.COM
ISMET
www.mps.org.uk NEW DOCTOR | VOLUME 3 - ISSUE 1 | 2010
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