The 'SAFE PT' Handover: Impact on Safe Patient Handover between Shifts in the Emergency Department

Abstract

Objectives: This paper studies the Impact of SAFE PT tool in the handover process between shifts in the Royal Hospital adult emergency department (ED) and its impact on clinical improvement, patient satisfaction and decrease in length of stay (LOS) of patients. The study provides an insight into the end user adaptability and their opinions. Methods: A prospective observational method; prior and post implementation survey comprising a questionnaire used to study the effects of the implementation of the SAFE PT handover. Results: 50 participants each were approached prior and post implementation of SAFE PT to fill descriptive questionnaires. The new SAFE PT tool was found to be clear and user friendly. It enhanced the handover process to a smooth one and was found to be systematic and highlighted the high acuity patients as well as red flags of each patient handed over. The bedside handover coupled with the prefilled written SAFE PT made it a safe process with increased patient satisfaction emphasized by the significant reduction in percentage of patient LOS in the ED. Conclusions: The SAFE PT handover proved to be a successful method of clinical handover between shifts in the ED with an impact on patient safety and care; leading to an increased patient satisfaction. It also contributed hugely to the reduction in the percentage of LOS of patients in the ED within 4 hours period. The result of the implementation of the new tool makes the ED proud to have a safe patient (SAFE PT) culture which is user friendly and one which has an emphasis on smooth patient flow. A ‘SAFE PT’ is indeed a ‘HAPPY PT’. its efficient execution. This is possible with a well-developed tool which assists in transforming relevant information of patients to be handed over between shifts in the ED [1]. The SAFE PT handover developed and discussed in our earlier study [2] depicts a standard structured format which is the key to an efficient handover system. The implementation of the SAFE PT handover and its impact on the ED is evaluated in this study. The clinical handover between shifts in ED is a complex matrix of multiple variables based in a difficult and unpredictable environment [3]. It’s of importance that time, place and format be invested towards a structured module for safe and smooth transition of patients between shifts. The aim of a high-quality handover is to have continuity of care in an efficient and smooth way so as not to hinder or delay the care of patients but quicken the process and eliminating errors [4]. The SAFE PT tool is a well-developed tool that identifies the patient and relevant details of management of the patient during the stay in the department. It was developed based on international guidelines [5,6]. It highlights red flags with regards to the patient that are to be addressed, thereby reducing errors. It provides the user with recommendations for further management of patient including pending investigations, imaging, consultations and disposition plan. An overview of the patient can be easily accessed by just glancing at the SAFE PT handover sheet; this ensures that information can be easily accessed in short period of time saving valuable time for both patient and physician. Introduction Clinical handover demands a structured format for ISSN: 2474-3674 DOI: 10.23937/2474-3674/1510088 Mikky et al. Int J Crit Care Emerg Med 2019, 5:088 • Page 2 of 10 • when the need arises. The handover practice that was being practiced was a verbal one between physicians on a one to one basis by the bedside of patients or on ad hoc basis when consultant requested for it. There was a lack of structured tool to transfer information between shifts. This demanded a humongous task of implementing an accurate handover system. Study design: The study conducted over a period of 12 weeks involved 50 participants each prior and post implementation of the SAFE PT handover system. It looked into user friendliness, compliance to the new tool and the impact it had on patient safety and satisfaction. Resources: Information was collected by survey questionnaires before and after the implementation of tool. The questionnaires assessed the type and format of the handover system and the impact the tool brought into the process. It also looked for incidents or hurdles that were asked to be mentioned and suggestions for improvement. Compliance was measured by daily monitoring of the filed forms of the SAFE PT tool that had been used during the handover process and were evaluated if any incidents missed that had been reported by the nursing in-charge on the same day. Impact of the tool on physician and patient were studied. The takeover team was observed and questioned for the positive and negative effects they encountered from the new system. Impact on patient flow and satisfaction was measured by monitoring patient complaints or its effect on LOS of patient in the ED. Period: SAFE PT implementation is studied in detail in the earlier study2 and the survey performed post implementation of the handover studied over a period of 12 weeks. The handover process is now a common practice at the end of shift in Royal Hospital adult ED. Data analysis: The pre and post implementation surveys of the SAFE PT tool involved questionnaires that were filled by middle grade and senior physicians and nurses. Statistical analysis: The data collected from ED nurses related to preparedness of safe handover model and improvement in patient care was exported to SPSS version 20. CHI SQUARE test was applied to test to establish an association between improvement in patient care and preparedness for safe handover method. H0: There is no association between department prepared for safe handover process and overall improvement in patient care OR H0: Improvement in patient care is independent of department prepared for safe handover process. (H0 = Hypothesis 0). H1: There is association between department prepared for safe handover process and overall improvement in patient care OR In the ED, there are multiple variables to distract a handover system. These factors need to be considered in large EDs divided into separate areas depending on acuity of care with high patient flow. This makes the handover a daunting task where it needs to prioritize patients over different sections of the department. So, it’s even more necessary to have a tool that gives the takeover team an overall view of the patients in the department with specific red flags to patients of concern, the management plan agreed by both teams initiated and to be continued, division of resources appropriate to the area and patient. The entire system being patient centric and ensuring no duplication of work with a definite continuity of care over shifts for increased patient satisfaction. The incoming team that takes over from the outgoing team needs a tool that is reliable and dependable so as to continue the work with no hitches or glitches making a deep impact on quality of care. The SAFE PT tool was designed based on the above criteria and its implementation initiated with a study to feel the impact it had on the culture in the Royal adult ED and measured with the help of quality Indicators [7,8].