Improving Medical Handover Using a Structured Handover Algorithm

Handover is an important part of clinical practice and its failure is a major preventable cause of patient harm. With increasingly varied work patterns for all healthcare professionals, ensuring good and effective handover is paramount. Guidance has been created to highlight key handover principles. However, clinical surveys show wide variability between hospitals with limited or no defined handover processes.
 
A single-centre quality improvement project with the implementation of a structured handover algorithm was performed, over five successive Plan-Do-Study-Act (PDSA) cycles. The inclusion of key elements identified in the literature as being important for effective handover were measured. These elements were assessed and monitored after the implementation of the structured handover algorithm and further interventions, including direct algorithm demonstration and change of handover location, as part of sequential PDSA cycles, following medical team (consultants, junior doctors and specialist nurses) consensus.
The baseline assessment of the hospital’s handover processes showed them to lack key handover elements. Through the introduction of the handover algorithm, the handover process improved significantly. Following the interventions all but two key handover elements were present in 100% of handovers with the two further elements present in at least 75% of handovers. These findings were sustained over five successive PDSA cycles.
 
A structured handover algorithm improves handover practice. The structured framework of the algorithm acts as an aid, avoiding key elements from being missed and imprinting them into routine handover practice. The improvement methodologies and interventions of this study can potentially benefit further clinical settings and be adapted accordingly.