Improving management of jobs handed to on call doctors during weekday medical ward cover

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Background & Problem

Handover is a high risk point for errors in clinical care which may lead to near misses and adverse events. In an acute hospital, on call services can be a risk for patients as an over stretched on call service can result in errors. The on call team handles emergencies, but it is estimated that 35% of tasks undertaken at night could have been completed during the day[1]. These tasks have been shown to be mainly routine, inappropriate and not related to acute medicine[2]. System inefficiencies can prevent the completion of routine daytime jobs which are passed on to the night team[2]. During weekday medical ward cover, the responsibility of clinical care depends on one junior doctor and a nurse practitioner. With such high clinical responsibility, there is need to ensure the safety of wards by ensuring systems are in place to reduce the number of routine jobs handed over from the day team.

Aim

Improve management of routine jobs handed to on call doctors during weekday medical ward cover by 50% by November 2017.

Method

• PDSA Cycle 1: Two medical wards with high number of handover jobs were identified based on questionnaires distributed to junior doctors.
• PDSA Cycle 2: Job check list and educational poster introduced in both wards.
• PDSA Cycle 3: Education of doctors and nurses on the wards
• PDSA Cycle 4: Meeting with ward doctors and nurses to agree actions and plan next step.

Results

Both wards showed some improvement in the number of handover jobs following the interventions however there is need to maintain this and improve further.

Implications

Simple changes such as a standardised checklist for organising day jobs can lead to changes in systems regarding handover. Job checklist can be scaled up to an electronic form which can be introduced to all other wards, alongside the educational poster.

Hospital at night and at weekends CG443.
Department of health: The implementation and impact of hospital at night pilot projects: an evaluation report.