Hand in Hand: Towards Safer Paediatric Handovers

Abstract

Background:

Handover is frightfully variable for children moved from Paediatric Intensive Care (PICU) to the General Paediatric ward. No one reliably knows what has happened, is happening or is planned. Parents are exasperated, children are worried, time-poor doctors are frustrated! This is a patient safety issue. It occurs frequently within a delicate system. A robust, versatile improvement was required.

Methods:

A high level process map was used to capture the ideal safe patient transfer of care handover pathway (work as imagined) and current variations in practice (work as is). A fishbone diagram helped establish the contributory factors. A histogram and pareto chart explored the extent of these contributory factors. 

The paediatric registrar team was encouraged to explore ideas around the safety of PICU stepdowns and the initial diagnostics were used to engage them. Change ideas were generated that have formed the basis of PDSA cycles.

Results:

Through the LSP QI Change Champions Programme, a clear aim and measure was brainstormed. They were rigorously streamlined as the PDSA cycles progressed, to obtain data of direct clinical relevance. The baseline measures showed there was room for improvement in the process. The first change idea of electronically documenting verbal handovers from PICU has been positively received and adopted into practice. As reflected in the run chart, documented verbal handovers have improved from 0% to 65%. As reflected in the PDSA summary table, some cohorts of paediatric registrars were accidentally omitted from the initial rollout, which contributed to most missed documentation. The run chart shows a trend towards improvement in the confidence of clinicians, having all the relevant information available to them, to safely clerk their PICU stepdown patients currently.    

Analysis:

Improved documentation has paved the way for risk areas to be better identified. This will form a basis for, and facilitate discussion between the general paediatric team and PICU. Developing and implementing an electronic handover proforma – the next PDSA cycle – will aim to standardise and structure handovers further. Each small, rapid PDSA test cycle, will continue to etch away at the barrier between patient safety and excellent clinical care.