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Found 115 results
  1. Content Article
    Handover is a critical process for ensuring quality and safety in healthcare, and research suggests that poor handover results in significant morbidity, mortality, dissatisfaction and increased financial costs. However, the safety of handover has not received much research attention to date. This study aimed to measure the perceived risk, degree of patient harm and the systems used to support handover, and to understand how this varied by care setting, type of clinical practice, location and level of experience. The authors suggest that the results of the study indicate that action needs to be taken to improve communication and reduce risk during all types of handovers. Clinical leaders should find ways to train and support handover with effective systems, particularly focusing on training less experienced staff. More research is needed to demonstrate which interventions improve the safety of handover.
  2. Content Article
    Handover in healthcare settings can be a time when the risk of error and harm is increased. This blog summarises the results of global survey that asked the opinions of healthcare workers on the safety of handover. It highlights ten key points raised by the results: Handover causes frequent errors and patient safety incidents Handover errors can cause serious harm to patients Most people think they are better than average at handover The longer you’ve been around, the scarier handover appears  Different types of handovers have a similar safety profile The safety of handover is a problem all over the world  Most practitioners use manual or informal systems to support handover EPR systems are not up to the job of supporting handover Staff need more training, and we need more time Healthcare leaders want better electronic systems The results of the survey have been published in Preprints.
  3. Content Article
    In order to become competent clinicians, doctors need to appropriately calibrate their clinical reasoning, but lack of follow-up after transitions of care can present a barrier to this. This study in the Journal of Hospital Medicine aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. The authors concluded that structured feedback for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.
  4. Content Article
    Research undertaken by digital health platform, CAREFUL shows that handover in hospitals is the cause of frequent and severe harm to patients.
  5. Content Article
    In this chapter, from the book 'Resilient Health Care, Volume 2: The Resilience of Everyday Clinical Work', Sujan et al. explore tensions and dynamic trade-offs through an example from our research on the safety of handover across care boundaries in emergency care. The authors describe the case study and then discuss the key theoretical concepts and their relationship to Resilience Engineering. It concludes the chapter with implications for research and for practice.
  6. Content Article
    Ambulance services in England are under immense pressure. In July 2022, all ambulance services in England declared REAP (Resource Escalation Action Plan) level four, reflecting potential service failure. Volumes of calls to 999 are increasing, patients in distress and pain are waiting longer for help to reach them, and ambulance teams feel unable to do their job well. The new Secretary of State for Health and Social Care has previously named cutting ambulance waits as his number one priority. As he takes up the role for the second time, he will again need to include ambulances in his list of priorities for the health and care system. Steps taken to date to help address the underlying issues have not yet had an impact on the pressures facing ambulance services. This analysis from The Health Foundation looks at ambulance service performance and explores the contributing factors and priorities for improvement.
  7. Content Article
    This investigation by the Healthcare Safety Investigation Branch (HSIB) explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. This is the second interim bulletin published as part of this investigation, and findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. The reference event in this investigation involves a patient who was found unconscious at home and taken to hospital by ambulance. They were then held in the ambulance at the emergency department for 3 hours and 20 minutes and during this time their condition did not improve. The patient was taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
  8. Content Article
    The Healthcare Safety Investigation Branch's (HSIB's) local investigation pilot aimed to evaluate the organisation's ability to carry out effective locality-based patient safety investigations with actions aimed at specific NHS organisations, while still identifying and sharing relevant national learning. It differs from HSIB's usual national investigations, which make safety recommendations to organisations that can make changes at a national level across the NHS in England. The pilot published three investigations focused on cross boundary and multi-agency safety events: Investigation 1: incorrect patient identification Investigation 2: incorrect patient details on handover Investigation 3: transfer of a patient with a stroke to emergency care The report summarises how the HSIB local investigation pilot was undertaken, and shares findings applicable to local healthcare systems including healthcare organisations and Integrated Care Systems.
  9. Content Article
    This Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
  10. Content Article
    On 23 September, Improvement Cymru, the all-Wales Improvement service for NHS Wales, hosted an online session with colleagues from Holland to talk about patient flow in hospital. 
  11. Content Article
    Due to the concerns around ambulance waiting times, the Healthcare Inspectorate Wales undertook a local review of the Welsh Ambulance Service Trust (WAST). The review explored how the risks to patients’ health, safety and wellbeing are managed whilst they are waiting for an ambulance. It assessed how patients are being managed by WAST’s three Clinical Contact Centres across Wales, from when a request for an ambulance is received to the point the ambulance arrives at the scene.
  12. Content Article
    As caseloads soar and new challenges related to the coronavirus keep emerging, efficiently sharing key information is crucial. Use the tips below to learn (or review) five ways to make safety huddles more effective.
  13. Content Article
    Emergency care needs fast, effective sharing of information. When clinicians have access to the information they need, they can better ensure safe and high-quality care for patients. To facilitate this, the Professional Record Standards Body (PRSB) has developed a standard for the information that is shared when care is transferred from ambulances to emergency departments. Once implemented, the standard for handover will improve continuity of care, as emergency care will have the information they need available to them on a timely basis. Whichever ambulance service brings the patient to the hospital, there will be a consistent set of information available to the emergency department. It means that patient safety will be improved, because emergency care professionals will know what medications have been administered, what diagnostic tests have been done, whether the patient has any allergies and other important information. Sharing clinical information with emergency care will also support professionals in arranging patient discharge and preventing unnecessary admissions.
  14. Content Article
    This paper, published by BMJ Quality & Safety, argues that discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment.
  15. Content Article
    This study, published in US journal Chest, looks at the case of a patient who experienced severe hypoglycemia due to an infusion of a higher-than-ordered insulin dose. The event could have been prevented if the insulin syringe pump was checked during the nursing shift handoff. Risk management exploration included direct observations of nursing shift handoffs, which highlighted common deficiencies in the process. This led to the development and implementation of a handoff protocol and the incorporation of handoff training into a simulation-based teamwork and communication workshop.
  16. Content Article
    This is a patient safety solution document from the World Health Organization, focusing on communication during handover. It includes suggested actions, potential barriers and also ways to engage patients and families.
  17. Content Article
    Children presenting to district general hospitals with critical illness may need transfer to a Paediatric Intensive Care Unit (PICU) by a specialist retrieval team.  Learning from these PICU transfers would help local hospitals identify areas for improvement to enhance patient safety and clinical care. Local hospital paediatricians often rely on updates from their retrieval service for information about their patients transferred to PICU.
  18. Content Article
    Transport of patients from the intensive care unit (ICU) to another area of the hospital can pose serious risks if the patient has not been assessed prior to transport. The Department of Critical Care Medicine, Calgary Health Region, experienced two adverse events during transport. A subgroup of the Department's Patient Safety and Adverse Events team developed an ICU patient transport decision scorecard. This tool was tested through Plan-Do-Study-Act cycles and further revised using human factors principles. Staff, especially novice nurses, found the tool extremely useful in determining patient preparedness for transport.
  19. Content Article
    HomeLink Healthcare (HLHC) has been providing clinical care in the home with Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHT) since January 2019, to release in-patient bed capacity and improve patient choice. The two organisations have co-created the service, NNUH at Home, creating additional capacity and promoting improvements in patient flow from hospital to home. A key feature of NNUH at Home is that it compliments and integrates with existing services, rather than replicating those already in place.
  20. Content Article
    Ward rounds happen each day with your clinical team. In order for them to standardise the way they are conducted East Lancashire Hospital NHS Trust has designed a ward round check list, this is to ensure that everyone gets the same safety checks and important discussions are had for every patient.
  21. Content Article
    High quality handovers are essential for safe healthcare and are used in many clinical situations. Miscommunication during handovers can lead to unnecessary diagnostic delays, patients not receiving required treatment, and medication errors. Miscommunication is one of the leading causes for adverse events resulting in death or serious injury to patients. The process of handovers can be improved, and the aim of this article is to provide practical guidance for clinicians on how to do this better.
  22. Content Article
    This blog has been written by a healthcare worker and demonstrates the reality of what it is like caring for patients and families while being chronically low on staff. They describe the impact this has on staff morale and the impact it has on patients, patients family members and the relationship between staff and patients.
  23. Content Article
    Pro Mukherjee, Emergency Department Consultant at Leicester Royal Infirmary, briefly defines the SBAR terms and explains how healthcare practitioners can use it to communicate effectively within the emergency department.
  24. Content Article
    The Care 24/7 team at Oxford University Hospitals NHS Foundation Trust has been investigating ways of providing integrated, seamless care to patients across all their hospital sites. One of the priorities identified by the team has been the formalisation of the clinical handover process between teams and shifts, but what does this formalisation process involve? How can it make care more consistent and safe? What does it involve for staff? Central to the successful change to clinical handover is the use of a standardised clinical communication tool (SBAR) but how does it work, what benefits can a standardised clinical communication tool bring to staff and the handover process? Formalising the handover process, using clinical communication tools, seems to bring benefit to both staff and patients, but what are the changes like and what impact do they have on staff? Can formalisation empower staff and ensure that their concerns are heard?
  25. Content Article
    Matthew’s story provides a compelling case for improving ambulance handover times, and for changing the behaviours and cultures that contribute to unnecessary waits for patients.
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