Improving Handover Instructions: Intervention Co-Design Process
Research type
Research Study
Full title
Enhancing Patient Safety Following Discharge from Hospital by Improving the Quality of Handover Instructions from Hospital to Primary Care Teams: A Co-Design Intervention Development Process
IRAS ID
292582
Contact name
Ara Darzi
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of Research
The aim of this study is to design an intervention to improve the quality of handover instructions for primary care teams.One in five patients experience an adverse event within three weeks of discharge. Preparing handover instructions is a key step in the transfer of care from hospitals to primary care providers. These handover instructions, as found in discharge summaries, contain important information enabling primary care providers to continue patient care safely in the community. A recent study (Markiewicz 2020) found that primary care staff in North West London considered poor quality handover instructions received from hospital teams to be the most important threat to safe patient transitions from hospital to primary care settings.
This study will bring together key stakeholders, including patients, carers and healthcare professionals, to design an intervention to improve the quality of handover instructions for primary care teams. Both hospital and primary care professionals, such as nurses, doctors, allied health professionals, pharmacists, administrative staff and those with expertise in clinical information technology, will be recruited. Patients will be recruited from groups identified in a previous study as being particularly at risk of harm following discharge; the elderly and frail, those with complex medical problems and taking >5 medications, or those discharged home on anticoagulant medication (e.g. aspirin, warfarin etc). The involvement of key stakeholders will help the intervention facilitate patient-centred care by working with existing processes, and without adding to the workload of NHS staff.
The workshops will take place on two days (4 and 3 hours plus breaks) via an online platform (e.g. MS Teams, Zoom) to minimise risk to participants given the ongoing Covid-19 pandemic. There will be an online questionnaire to complete between workshops.
By improving the quality of handover instructions for community teams we hope this intervention will make patient discharges to community settings safer.
Summary of Results
Participants made recommendations for an educational intervention targeting junior doctors to improve discharge summaries, resulting in a multi-faceted intervention involving six main elements:
1. Workshop on how to prepare discharge summaries.
2. Ongoing assessment and feedback from senior doctors, peers, patients and carers
3. Peer support in the form of “buddies” to support new starts in preparing discharge summaries.
4. Online modules.
5. Displayed reference information (such as easy to access files with contact information, local processes, how-to guides)
6. An acronym outlining important considerations when preparing discharge summaries (RE-ACT: easily Readable, plain English, Actions and ownership, Changes to medications and Timeline for actions).Some other key recommendations included:
1. The intervention will require initial investment, financially as well as human resources, both of which are imperative for the intervention to have the desired results.
2. The intervention will require buy-in from senior staff from across the multi-disciplinary team and management team.
3. The intervention cannot be a “one off” event, but should consist of multiple, short interventions which can be delivered at many time points throughout doctors’ rotations.
4. Patients and carers, as well as primary care, should be involved in the design and delivery of this intervention where possible, to ensure it remains patient centred at all times.REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
21/NW/0111
Date of REC Opinion
26 May 2021
REC opinion
Further Information Favourable Opinion