title: Improving patient handover between teams using a business improvement model: PDSA cycle.
abstract: BACKGROUND
  Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue.
  
  
  METHODS
  P - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit.
  
  
  RESULTS
  S - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover.
  
  
  CONCLUSIONS
  Using a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.
authors.affiliation: Cardiology ST4 in the Department of Cardiology and General Medicine, Ealing Hospital, Middlesex.
authors.forename: Vishal
authors.initials: V
authors.lastname: Luther
authors.affiliation: Core Medical Trainee Year 1 in the Department of Gastroenterology and General Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hammersley
authors.affiliation: Consultant Anaesthetist and Lead of the Whittington Hospital Clinical Leadership and Management Programme, Department of Anaesthetics, Whittington Hospital, London.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Chekairi
mesh_terms: D004282:Documentation; D006801:Humans; D017146:Models, Organizational; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D011795:Surveys and Questionnaires