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Getting a Handle on Handover: Improving the E-Handover Process for Duty Doctors in Psychiatry
- Emily Ong, Emma Docherty, Gillian Cuthbertson, Eugene Wong
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S87
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- Article
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Aims
Effective handover is a vital aspect of patient safety and continuity of care. On-call junior doctors (the Duty Doctor) in psychiatry inpatient wards in University Hospital Hairmyres (UHH) and University Hospital Wishaw (UHW) use an electronic handover tool (e-handover) to supplement handover. This lists outstanding jobs and information to be aware of. This project aimed to improve the handover process by making amendments to the e-handover.
MethodsA Plan, Do, See, Act (PDSA) cycle structured the project. An electronic survey was sent to all 30 Duty Doctors. This contained a Likert scale, 1 being negative and 10 being positive, to rate the handover process, alongside space for free text comments to be given. Thematic analysis identified common themes within these comments.
Changes were implemented in response to the survey findings. Space was added to the e-handover for each patient's care team (parent team), as well as their contact details. The Duty Doctors were informed of the changes and a post-intervention survey was sent six weeks later.
ResultsThere was a total of 22 responses (73.3%) to the pre-intervention survey. Themes identified from the free text comments included: Organisation of tasks; Ease of use; Reliability; Inappropriate use; Technical issues; Handover update; Task information and Ward information. The most common theme was inappropriate use of e-handover. It was identified that tasks were being added to the e-handover that would be more appropriately actioned by the parent team.
There was a total of 12 responses (40%) to the post-intervention survey. A demonstrable improvement in the rating of the handover process was found. Free text comments showed that the changes made were helpful. Common themes were identified from the comments. One theme was ‘Missing information’, which included a lack of clarity on the date a job was added to the e-handover. Future changes could include adding space to the e-handover for this information.
ConclusionFollowing the adjustments made to the e-handover there was an improvement in the satisfaction amongst the Duty Doctors.
One limitation identified was the lower response rate for the post intervention survey. We postulated that this was due to the survey being distributed when junior doctors changed clinical rotations and left the Duty Doctor role. This could be considered for future improvement cycles.
Additionally, free text comments from the post intervention survey could be utilised to inform future improvements.
Pre-Stroke Frailty Is Independently Associated With Post-Stroke Cognition: A Cross-Sectional Study
- Martin Taylor-Rowan, Ruth Keir, Gillian Cuthbertson, Robert Shaw, Bogna Drozdowska, Emma Elliott, Jonathan Evans, David Stott, Terence J. Quinn
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 5 / May 2019
- Published online by Cambridge University Press:
- 01 March 2019, pp. 501-506
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Objective: Post-stroke cognitive impairment is common, but mechanisms and risk factors are poorly understood. Frailty may be an important risk factor for cognitive impairment after stroke. We investigated the association between pre-stroke frailty and acute post-stoke cognition. Methods: We studied consecutively admitted acute stroke patients in a single urban teaching hospital during three recruitment waves between May 2016 and December 2017. Cognition was assessed using the Mini-Montreal Cognitive Assessment (min=0; max=12). A Frailty Index was used to generate frailty scores for each patient (min=0; max=100). Clinical and demographic information were collected, including pre-stroke cognition, delirium, and stroke-severity. We conducted univariate and multiple-linear regression analyses with covariates forced in (covariates included were: age, sex, stroke severity, stroke-type, pre-stroke cognitive impairment, delirium, previous stroke/transient ischemic attack) to investigate the association between pre-stroke frailty and post-stroke cognition. Results: Complete data were available for 154 stroke patients. Mean age was 68 years (SD=11; range=32–97); 93 (60%) were male. Median mini-Montreal Cognitive Assessment score was 8 (IQR=4–12). Mean Frailty Index score was 18 (SD=11). Pre-stroke cognitive impairment was apparent in 13/154 (8%) patients. Pre-stroke frailty was significantly associated with lower post-stroke cognition (Standardized-Beta=−0.40; p<0.001) and this association was independent of covariates (Unstandardized-Beta=−0.05; p=0.005). Additional significant variables in the multiple regression model were age (Unstandardized-Beta=−0.05; p=0.002), delirium (Unstandardized-Beta=−2.81; p<0.001), pre-stroke cognitive impairment (Unstandardized-Beta=−2.28; p=0.001), and stroke-severity (Unstandardized-Beta=−0.20; p<0.001). Conclusions: Pre-stroke frailty may be a moderator of post-stroke cognition, independent of other well-established post-stroke cognitive impairment risk factors. (JINS, 2019, 25, 501–506)