Safer Clinical Systems: Birmingham Children’s Hospital NHS Foundation Trust

A team at Birmingham Children’s Hospital worked on a project to implement an innovative hospital handover at night process.

The process of successfully handing over patient medical and care information between day and night staff is challenging. The hospital follows the hospital at night (HAN) service model which can require active participation of up to 13 specialities. Feedback from staff indicated that handovers were often poor.

With this project, the team planned to develop an understanding of the whole-system constraints preventing successful handovers and implement the changes necessary for improvement.

Focus areas included:

• Review of written handover systems.
• Improving multidisciplinary handover.
• Developing a workplace-based observational tool to assess junior doctor and nursing behaviours at handover.
• Expansion of the HAN service to include cross-cover of all surgical patients.

Benefits

Overall the project aimed to demonstrate improvement in the organisation’s safety culture, in the following ways:

• fewer serious incidents requiring investigation (SIRI)
• reducing handovers as the root cause in SIRI to less than 25%
• qualitative feedback from Board Quality and Safety walkabouts focusing on surgical handover and out-of-hours care
• reducing unplanned admissions to paediatric intensive care unit
• reducing the number of clinically significant events in which staff report the shift handover failed to prepare them
• improving handover behaviours, measured through observed ‘microaudits’
• reduction in the transfer of daytime specific tasks to out-of-hours working
• increasing proactive out-of-hours review of at risk children
• improving the experience of 24-hour care for the patient and their family so that it feels seamless and continuous.