title: Implementing electronic handover: interventions to improve efficiency, safety and sustainability.
abstract: OBJECTIVE
  Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH).
  
  
  METHODS
  There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use.
  
  
  METHODS
  A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues.
  
  
  METHODS
  Innovative solutions using media and online software provided cost-efficient measures to improve compliance.
  
  
  RESULTS
  The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool.
  
  
  CONCLUSIONS
  An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability.
authors: Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Sharifah Munirah
authors: SM
authors: Alhamid
authors: Clinical Services and Improvement, Division of Medicine, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Desmond Xue-Yuan
authors: DX
authors: Lee
authors: Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Hei Man
authors: HM
authors: Wong
authors: Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Matthew Bingfeng
authors: MB
authors: Chuah
authors: Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Yu Jun
authors: YJ
authors: Wong
authors: Internal Medicine Residency, Singapore Health Services, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Kaavya
authors: K
authors: Narasimhalu
authors: Department of Infectious Diseases, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Thuan Tong
authors: TT
authors: Tan
authors: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, 169608, Singapore.
authors: Su Ying
authors: SY
authors: Low
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D057286:Electronic Health Records; D006801:Humans; D062209:Patient Handoff / Q000458:organization & administration*; D061214:Patient Safety; D058996:Quality Improvement
keywords: electronic handover; patient handovers; patient safety; quality improvement