The Health Roundtable

NSW Safe Clinical Handover Program

Presenter: James DunneAgency for Clinical Innovation

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

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KEY PROBLEM

Poor patient handover contributes to adverse patient outcomes

Root Cause Analysis data

The Special Commission of Inquiry (Garling)

Australian Commission on Safety and Quality in Health Care – National Clinical Handover Initiative

World Health Organisation – one of WHO’s top 5 priorities

Between the Flags – Recognition and management of the deteriorating patient

MJA supplement, “Clinical Handover : Critical Information” – supplement of 14 papers published on 1st June 2009

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AIM OF THIS INNOVATION

To implement standard key principles for clinical handover across the care continuum

Standard Key Principles

Acute Care Taskforce

Standard key principles + flexible standardisation

= System level change

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BASELINE DATASome key scenarios were clearly identified as high risk for safe patient handover, following review of RCA and IIMS data:

Escalation of deteriorating patients High acuity to low acuity transfer (e.g. ICU to ward or recovery unit to

ward) Junior to senior clinicians (particularly between medical teams) Inter-facility transfer Community and General Practice to hospital Hospital to community and General Practice Transfer of mental health patients Emergency Department to ward Multidisciplinary team handover Nursing / midwife shift to shift handover

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KEY CHANGES IMPLEMENTED

Standard Key Principles

1. Leadership

2. Valuing handover

3. Handover participants

4. Handover time

5. Handover place

6. Handover process

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NEXT STEPS

2009 2010 2011 2012

Transition governance

DevelopImplement & monitor

DevelopImplement & monitor

DevelopImplement & monitor

Support, networking

and ongoing

monitoring

Standard key principles

JMO shift change handover

GP/Hospital handover

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OUTCOMES SO FAR All Area Health Services (now LHDs) + Children’s Hospital at Westmead, Justice

Health and the Ambulance Service of NSW (Health Services) have submitted an implementation plan for Safe Clinical Handover.

All Health Services have hosted an implementation monitoring site visit

with members of the Acute Care Taskforce. Bedside nursing and midwifery handover strategy is consistently being

implemented in organisations. Taped handover is being eradicated from all Health Services Significant energy and strategy are ensuring engagement of medical teams in

clinical handover improvement. 85% at the facility level agreed / strongly agreed that ‘The statewide Safe Clinical

Handover Program has assisted our department/unit to implement and/or improve our clinical handover process’1

1Clinical Excellence Commission Quality Systems Assessment (2010) 7

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LESSONS LEARNT

Principle based approach Flexible standardisiation Distilling the work of many Sponsorship Leverage from other changes in the system Sharing our work

www.archi.net.au

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