A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

This project was intended to observe the handover of trauma and orthopaedic patients at a district general hospital in the UK. Following the implementation of a standard operating protocol, the handover of patient information improved including neck of femur fracture patients significantly. The study can therefore be utilised by other similarly structured departments to improve the handover process, thereby improving patient safety.

Study Overview

• Status: Completed
• Conditions: Fractures, Bone; Orthopedic Disorder; Neck of Femur Fracture
• Intervention / Treatment: Other: Standard Operating Protocol

Detailed Description

Poor handover and inadequate transmission of clinical information between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital.

A prospective single centre observational study was performed at an acute NHS trust, using the Plan-Do-Study-Act (PDSA) methodology. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeon's recommendations for effective handover (2007) to create a standard operating protocol (SOP). Following the implementation of the SOP, a further 8 consecutive weekday trauma meetings, involving a further 47 patients, were observed. The data collection was performed by 5 trained independent observers. The data was analysed using t test for quantitative variables and chi-square or Fisher's exact tests for categorical variables.

• Study Type: Observational
• Enrollment (Actual): 317

Contacts and Locations

Study Locations

• United Kingdom
  • West Bromwich, United Kingdom
    • Sandwell Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Trauma and Orthopaedic patients.

Description

Inclusion Criteria:

• All patients that were handed over were included in the study.

Exclusion Criteria:

• Nil.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pre-Intervention Group; The verbal and written handover of these patients was observed. This included 146 general orthopaedic admissions patients and 43 trauma patients. All patient data was anonymised.
Post-Intervention Group; The verbal and written handover of these patients was observed after the introduction of the intervention. This included 81 general orthopaedic admissions patients and 47 trauma patients. All patient data was anonymised.	Other: Standard Operating Protocol; This was a written protocol on how the handover process should be conducted.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To assess the efficacy of the handover of trauma patients going to theatre.	A calculation was performed of how many patients had information handed over to the day staff. This included if a patient's past medical history, investigation results, plan, consent status, mark status and starvation status was handed over either written or verbally. This was expressed as a percentage.	Up to 6 weeks.
To assess the handover of neck of femur (NOF) fracture patients.	A calculation was performed of how many patients with NOF fractures had information handed over. This included the patient's age, mechanism of injury, past medical history, investigation results, plan, consent status, mark status, starvation status, scoring system calculation and discussion with next of kin regarding resuscitation status. For each of these domains for each patient, if the information was handed over, this was noted and was expressed as a percentage.	Up to 6 weeks.
To determine if unwell patients were being handed over from the admissions list or patients already on the ward.	From the handover meetings that were observed, it was noted whether 'unwell' patients from the ward had been handed over. This was expressed as a percentage from all the meetings that were observed.	Up to 6 weeks.

Collaborators and Investigators

• Sponsor: Sandwell & West Birmingham Hospitals NHS Trust
• Investigators: Study Director: Collette Samuels, Audit Co-Ordinator Sandwell Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 23, 2019
• Primary Completion (Actual): December 13, 2019
• Study Completion (Actual): December 13, 2019

Study Registration Dates

• First Submitted: August 6, 2020
• First Submitted That Met QC Criteria: August 12, 2020
• First Posted (Actual): August 17, 2020

Study Record Updates

• Last Update Posted (Actual): August 17, 2020
• Last Update Submitted That Met QC Criteria: August 12, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Hip Injuries; Hip Fractures; Femoral Fractures; Fractures, Bone; Musculoskeletal Diseases; Femoral Neck Fractures
• Other Study ID Numbers: QIP Trauma Meetings Sandwell

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No