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09-01-2012 | Medical management | Article

‘ABC’ facilitates emergency department shift handover


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MedWire News: Two papers in the Emergency Medicine Journal outline the development and pilot trial of "The ABC of Handover" tool.

The tool, which has content grouped under A, B, C, D, and E headings, is designed for use by the senior doctor leading the emergency department (ED) shift and takes just 5 minutes to complete, report Maisse Farhan (St Mary's Hospital, London, UK) and colleagues.

Use of the tool "led to a change in culture to one of anticipation and proactive management of potential issues on a shift, and achieved clinical improvements," they say, adding that it can be easily adapted for use in nursing handovers, and by other specialties.

The researchers reviewed the literature, observed 41 shift handovers in their ED, and conducted semi-structured interviews with 15 ED staff, before constructing a handover aid based on the results.

In the ABC handover tool, the A category comprises "Areas" and "Allocation," covering details of patient numbers and waiting times, and the doctor allocation to each area. Category B covers "Beds," "Bugs" (infection control issues), and "Breaches" (patients approaching the waiting time deadline).

Category C contains "Colleagues" (staffing issues, including porters and laboratories) and "Consultant on Call." The D category contains "Deaths," "Disasters" (clinical incidents or need for extra security), and "Deserters" (patients who leave before completion of treatment).

The final category, E, comprises "Equipment" (reporting failures or shortages) and "External Events" (local sporting events or carnivals that could result in ED admissions, plus hospital events such as audits and teaching).

The researchers tested the effect of the handover tool in their ED. In shifts observed before its implementation, handover of clinical information was high, but handover of operational information, such as bed availability, equipment failures, and staff sickness, was low.

The handover of "essential" items rose from 34% in 41 shift handovers before the implementation of the tool to 86% in 42 shift handovers in which the tool was used, with an average 74% improvement in the handover of operational items.

The increased handover of these issues generally resulted in staff anticipating problems and taking steps to avoid them. For example, the handover of the lack of a phlebotomy assistant led staff to plan to take blood themselves as needed, avoiding delays in blood tests.

Eighteen of 21 ED staff who completed a questionnaire felt that the tool significantly improved handover, and 19 felt it improved handover when given by locums. "This is important as it demonstrates that the ABC method standardises handover and can be readily used by unfamiliar locum doctors," say Farhan et al.

By Eleanor McDermid

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