Objectives A two-part study identifying best practice for shift handover and introducing a new handover tool; the ABC of Handover. We evaluate its impact and explore user opinions. The ABC tool aims to standardise handover providing effective transition of responsibility in the E.D; enhancing patient safety.
Methods Part 1 consensus based study; structured interviews identified current practice of handover. Best practice was identified and the ABC mnemonic was developed to classify information. Part 2: prospective observational before-and-after study exploring the effect of The ABC of Handover on clinical and organisational practice; measured by observing handovers and verifying the information transmitted by comparing to actual events occurring during the shift (providing a score). Observations were repeated after implementation of The ABC of Handover. Finally, questionnaire were used to appraise the tool.
Results Interviews revealed lack of standardised practice and identified best practice including clinical and operational strategies to organise the next shift. The ABC method was developed which grouped “best practice” under those headings.
41 handovers were observed before implementation and 42 after. Each handover was given a score according to the number of items it contained that were necessary to that particular shift. The mean score given to handovers pre-implementation was 34% with a modal value of 50%. Using The ABC of Handover the mean score was 86% with a modal value of 100%. All participants reported ease of use and improvement with the ABC tool.
Conclusions This study demonstrates disparity in the understanding of shift handover and identifies best practice in the ABC of Handover which standardised and improved handover. It was successfully implemented and led to a change of practice and a global improvement, providing a framework for safe transition of shift responsibility. This can be used for training in handover for medical and nursing staff in the ED.
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