A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

• ClinicalTrials.gov Identifier: NCT04514601
• Recruitment Status: Completed
• First Posted: August 17, 2020
• Last Update Posted: August 17, 2020
• Sponsor: Sandwell & West Birmingham Hospitals NHS Trust
• Information provided by (Responsible Party): Salman Sadiq, Sandwell & West Birmingham Hospitals NHS Trust

Study Description

Brief Summary:

This project was intended to observe the handover of trauma and orthopaedic patients at a district general hospital in the UK. Following the implementation of a standard operating protocol, the handover of patient information improved including neck of femur fracture patients significantly. The study can therefore be utilised by other similarly structured departments to improve the handover process, thereby improving patient safety.

Condition or disease	Intervention/treatment
Neck of Femur Fracture; Fractures, Bone; Orthopedic Disorder	Other: Standard Operating Protocol

Detailed Description:

Poor handover and inadequate transmission of clinical information between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital.

A prospective single centre observational study was performed at an acute NHS trust, using the Plan-Do-Study-Act (PDSA) methodology. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeon's recommendations for effective handover (2007) to create a standard operating protocol (SOP). Following the implementation of the SOP, a further 8 consecutive weekday trauma meetings, involving a further 47 patients, were observed. The data collection was performed by 5 trained independent observers. The data was analysed using t test for quantitative variables and chi-square or Fisher's exact tests for categorical variables.

Study Design

• Study Type: Observational
• Actual Enrollment: 317 participants
• Observational Model: Cohort
• Time Perspective: Retrospective
• Official Title: A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings
• Actual Study Start Date: October 23, 2019
• Actual Primary Completion Date: December 13, 2019
• Actual Study Completion Date: December 13, 2019

Groups and Cohorts

Group/Cohort	Intervention/treatment
Pre-Intervention Group; The verbal and written handover of these patients was observed. This included 146 general orthopaedic admissions patients and 43 trauma patients. All patient data was anonymised.
Post-Intervention Group; The verbal and written handover of these patients was observed after the introduction of the intervention. This included 81 general orthopaedic admissions patients and 47 trauma patients. All patient data was anonymised.	Other: Standard Operating Protocol; This was a written protocol on how the handover process should be conducted.

Outcome Measures

Primary Outcome Measures :

1. To assess the efficacy of the handover of trauma patients going to theatre. [ Time Frame: Up to 6 weeks. ]
   A calculation was performed of how many patients had information handed over to the day staff. This included if a patient's past medical history, investigation results, plan, consent status, mark status and starvation status was handed over either written or verbally. This was expressed as a percentage.
2. To assess the handover of neck of femur (NOF) fracture patients. [ Time Frame: Up to 6 weeks. ]
   A calculation was performed of how many patients with NOF fractures had information handed over. This included the patient's age, mechanism of injury, past medical history, investigation results, plan, consent status, mark status, starvation status, scoring system calculation and discussion with next of kin regarding resuscitation status. For each of these domains for each patient, if the information was handed over, this was noted and was expressed as a percentage.
3. To determine if unwell patients were being handed over from the admissions list or patients already on the ward. [ Time Frame: Up to 6 weeks. ]
   From the handover meetings that were observed, it was noted whether 'unwell' patients from the ward had been handed over. This was expressed as a percentage from all the meetings that were observed.

Eligibility Criteria

• Ages Eligible for Study: Child, Adult, Older Adult
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Probability Sample

Study Population

Trauma and Orthopaedic patients.

Criteria

Inclusion Criteria:

• All patients that were handed over were included in the study.

Exclusion Criteria:

• Nil.

Contacts and Locations

Locations

United Kingdom

Sandwell Hospital

West Bromwich, United Kingdom

Sponsors and Collaborators

Sandwell & West Birmingham Hospitals NHS Trust

Investigators

• Study Director: Collette Samuels; Audit Co-Ordinator Sandwell Hospital

More Information

• Responsible Party: Salman Sadiq, Foundation Year 2 Doctor, Sandwell & West Birmingham Hospitals NHS Trust
• ClinicalTrials.gov Identifier: NCT04514601
• Other Study ID Numbers: QIP Trauma Meetings Sandwell
• First Posted: August 17, 2020
• Last Update Posted: August 17, 2020
• Last Verified: August 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Musculoskeletal Diseases; Fractures, Bone; Femoral Fractures; Femoral Neck Fractures; Wounds and Injuries; Leg Injuries; Hip Fractures; Hip Injuries