WISER - Weekend Clinical Handover Policy is Effective in Reducing Patient’s Risk: Experience from Department of Medicine and Therapeutics, Prince of Wales Hospital

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Authors (including presenting author) :
Chan CHH (1), Choy SM (1), Li CM (1), Ho WS (1), Chow KM (1)
Affiliation :
(1) Department of Medicine and Therapeutics, Prince of Wales Hospital
Introduction :
Effective clinical handover is an essential team process and a critical component of continuity of care ensuring safety to patients. Structured framework with good quality communication and documentation form the essential parts of clinical handover. Suboptimal clinical handover may lead to patient safety issues, especially medication errors. However, there was no standard policy in this area in our department.
Objectives :
The aim of this policy is to standardize and promote the practice of effective handover over weekends/leaves in order to: 1. Enhance continuity of care 2. Improve patient safety 3. Improve efficiency 4. Facilitate patient turnover
Methodology :
Any frontline doctor who has first round duties and has scheduled leave (including weekends) for at least 1 day were required to use standardized clinical handover. Standardized clinical handover practice and format before leave and weekend was promulgated by e-mail with explanation given during department audit meeting followed by email. The following items were included for the standardized clinical handover: 1. A problem list or provisional diagnosis 2. Issues need to be handed over during leave (e.g. follow investigation results, blood tests, duration of treatment, discharge plan) 3. If the patient is planned to be discharged when the case MO is on leave, the follow up plan and medication regimen upon discharge, highlighting any change during current hospitalization should be documented Pre and post-implementation audits were conducted to evaluate the compliance rate of the above items. In addition, a survey (Likert scale; 1 = strongly disagree; 6 = strongly agree) was conducted to evaluate the effectiveness of the policy.
Result & Outcome :
Before the policy implementation, the compliance to standard clinical handover over weekend was 53%. Marked improvement in the compliance was noted after promulgation with latest compliance rate 84%. Regular reminders to staffs and audits of the compliance rate will be conducted to ensure sustainability. 30 colleagues completed the survey. They agree that the policy effectively reduce the chances of missing important clinical problems that require attention over weekend (average: 5.5/6) and may reduce weekend discharge medication error (average 5.46/6). With the policy, they are more willing to discharge patients over weekend (average 5.56/6) and they also feel that the time spent for holiday round can be reduced (average 5.6/6). Overall, they strongly agree that the policy is effective in improving patient’s safety (average 5.7/6). To conclude, weekend clinical handover policy is effective in reducing patient’s risk over weekend and leave of case MO.

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