title: Implementation of a new tool to improve the efficacy and safety of surgical handovers.
abstract: OBJECTIVE
  Compliance with European working time regulations in surgical practice has resulted in an increase in the number of clinicians caring for individual patients and subsequently an increase in the frequency of handovers. In 2007, the Royal College of Surgeons of England produced guidelines on the minimum data-set for 'safe handover'. This audit examined compliance with these guidelines before and after adopting a more detailed electronic handover 'template' with the intention of improving handover quality and patient safety.
  
  
  METHODS
  Pre-existing surgical 'take' electronic handover sheets were reviewed daily for two weeks to assess compliance with published guidance. A new proforma was introduced, training delivered and compliance re-audited. χ2 analysis was performed to determine statistical significance.
  
  
  RESULTS
  The handovers of 118 patients were audited before, and 114 after, the implementation of the new proforma. Name and responsible consultant were recorded in all cases. Age (52% vs. 85%, p=<0.01), location (77% vs. 95%, p=<0.01), admission date (0% vs. 39%, p=<0.01), medical history (82% vs. 94%, p=0.01), diagnosis (55% vs. 93%, p=<0.01) and management plan (81% vs. 97%, p=<0.01) showed a statistically significant improvement with the new proforma. Presenting complaint (93% vs. 98%) and investigation (90% vs. 90%) data remained good. Review frequency (5%vs.11%) and outstanding tasks (21% vs. 27%) were poorly documented.
  
  
  CONCLUSIONS
  Significant improvement was seen in the completeness of information handed-over following the introduction of the new proforma with likely positive implications for patient safety and standard of care. Opportunity for improvement still remains however, and more specific focussed tuition for trainees is required.
authors.affiliation: Department of General Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, England, United Kingdom. Electronic address: emma.blower@nhs.net.
authors.forename: E L
authors.initials: EL
authors.lastname: Blower
authors.affiliation: Department of General Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, England, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: MacCarrick
authors.affiliation: Department of General Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, England, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Forster
authors.affiliation: Department of General Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, England, United Kingdom.
authors.forename: P A
authors.initials: PA
authors.lastname: Sutton
authors.affiliation: Department of General Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, England, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Vimalachandran
mesh_terms: D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic / Q000592:standards; D006284:Health Plan Implementation / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D062209:Patient Handoff / Q000592:standards* / Q000706:statistics & numerical data; D061214:Patient Safety; D058996:Quality Improvement / Q000592:standards
keywords: Education; European working time regulations; Handover; Patient safety; Quality improvement