Improving care of the older person service through implementation of a paired electronic and verbal handover process

Background: A QIP conducted within the geriatrics department at University Hospital Coventry & Warwickshire, led by a team of resident doctors under consultant supervision. 

Introduction: Efficient handovers are an essential part of safe care and geriatric medicine has unique challenges due to complex patient needs, nuanced decision making and requiring continuity of care. The Royal College of Physicians (RCP) recommends standardised, dynamic handovers with digital and face-to-face components. Our departmental out of hours handover process was perceived as inefficient by resident doctors. This QIP aimed to formally evaluate and improve handover processes, to enhance service efficiency and patient outcomes.

Methods: Two PDSA cycles were conducted. Resident doctors were surveyed regarding handover practices which identified flaws including inefficiency, high error potential and limited scope for communication. Key measures included time expenditure, ease of use and user satisfaction. The data was reviewed alongside RCP recommendations to help devise and implement interventions, and staff were re-surveyed 10 weeks later. The first cycle integrated the handover process directly into the trust’s Electronic Patient Record (EPR). Following successful implementation, the second cycle expanded this intervention to a second ward and added an in-person handover. 

Results: Transitioning to an EPR-integrated handover system improved user satisfaction, perceived efficiency, and accessibility. Doctors reported an average time saving of 15 minutes per individual per shift. The addition of an in-person handover enhanced the handover experience. 

Conclusion: This QIP demonstrated an improvement in the geriatric departmental handover process, aligning it with RCP recommendations through digital integration and the addition of a face-to-face component. Improved handover efficiency, functionality, and communication are expected to have positive effects on the care of our frail older patients. Future steps include extension to the full department and potentially adoption across the Trust.