Republished: creating a safe, reliable hospital at night handover: a case study in implementation science.
Background: We developed protocols to handover patients from day to hospital at night (H@N) teams.Setting: NHS paediatric specialist hospital.Method: We observed four handover protocols (baseline, Phases 1, 2 and 3) over 2 years. A mixed-method study (observation, interviews, task analysis, prospect...
| Publicado en: | Postgraduate Medical Journal Vol. 90; no. 1067; pp. 493 - 502 |
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| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Oxford University Press / USA
Sep2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109676129&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 109676129 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00325473 4FZ jtl: Postgraduate Medical Journal issn: 00325473 maglogo: N pubinfo: dt: Sep2014 vid: 90 iid: 1067 pid: 622 pub: Oxford University Press / USA artinfo: ui: 109676129 NLM25140006 2012692452 10.1136/postgradmedj-2013-002146rep NLM25140006 109676129 ppf: 493 ppct: 9 formats: tig: atl: Republished: creating a safe, reliable hospital at night handover: a case study in implementation science. aug: au: McQuillan, Annette Carthey, Jane Catchpole, Ken McCulloch, Peter Ridout, Deborah A Goldman, Allan P sug: ab: Background: We developed protocols to handover patients from day to hospital at night (H@N) teams.Setting: NHS paediatric specialist hospital.Method: We observed four handover protocols (baseline, Phases 1, 2 and 3) over 2 years. A mixed-method study (observation, interviews, task analysis, prospective risk assessment, document and case note review) explored the impact of different protocols on performance.Intervention: In Phase 1, a handover protocol was introduced to resolve problems with the baseline H@N handover. Following this intervention, two further revisions to the handover occurred, driven by staff feedback (Phases 2 and 3).Results: Variations in performance between handover protocols on three process measures, start time efficiency, total length of handover, and number of distractions and interruptions, were identified. Univariate regression analysis showed statistically significant differences between handover protocols on two surrogate outcome measures: number of flagging omissions and the number of out of hours deteriorations (p=0.04 for Phase 3 vs Phase 1 for both measures (CI 1.04 to 4.08; CI 1.03 to 4.33), and for Phase 3 vs Phase 2 (p=0.006 and p=0.001 (CI 1.22 to 5.15; CI 1.62 to 9.0)), respectively). The Phase 1 and 2 handover protocols were effective at identifying patients whose clinical condition warranted review overnight. Performance on both surrogate outcome measures, length of handover and distractions, deteriorated in Phase 3.Conclusions: A carefully designed prioritisation process within the H@N handover can be effective at flagging acutely unwell patients. However, the protocol we introduced was unsustainable. In a complex healthcare system, sustainable implementation of new processes may be threatened by conflicting goals. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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