Improving medical night handover: strengthening teamwork, efficiency and critical patient care
Introduction: Handover between teams is crucial for ensuring safe care during overnight shifts. In NHS hospitals, the acute take and inpatient wards often manage a high volume of critically ill patients requiring medical reviews, some of whom may need escalation to intensive care. A structured hando...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525001894 |
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| Summary: | Introduction: Handover between teams is crucial for ensuring safe care during overnight shifts. In NHS hospitals, the acute take and inpatient wards often manage a high volume of critically ill patients requiring medical reviews, some of whom may need escalation to intensive care. A structured handover process not only helps to identify these patients early, but also fosters improved collaboration between medical and intensive care teams. As part of the Royal College of Physicians Chief Registrar program, we initiated a quality improvement project (QIP) aimed at enhancing the medical night handover process, specifically to streamline handover and incorporate the critical care team. Materials and methods: This QIP was implemented at a large district general hospital where the night medical team consists of two registrars, three SHOs, and two FY1s. Two key changes were introduced to the existing handover structure. The first was to divide the acute take and inpatient wards into two smaller handover sessions, each led by a registrar. This was to provide registrars with improved oversight of the acuity and volume of tasks, enabling more effective triage. The second change involved including the overnight Critical Care Outreach Team (CCOT) in both handover sessions. This was designed to improve two-way communication between the CCOT and medical registrars regarding unwell patients throughout the hospital. Surveys were distributed to doctors working in medicine and intensive care both before and after the modifications, to assess their impact. Key measures included team cohesion, communication and accessibility between medicine and ICU, and time efficiency. Results and discussion: The surveys were answered by a range of doctors, from FY1 to registrar level. 92.9% of those responding felt that the new structure improved the running of handover, used time more efficiently and helped to highlight who the out-of-hours team were. All respondees thought that the new structure improved the identification of unwell patients and the triaging of jobs. Respondents felt more aware of who team members were on each shift, there was improved cardiac arrest team cohesion, and there was a greater feeling that medical/ICU collaboration was helpful when making escalation decisions (Table 1). Free-text comments similarly highlighted the positive impact of ICU team attendance at handover, and it was felt that this also provided valuable learning opportunities for junior colleagues. Conclusion: This QIP highlights that handover structure can have a significant impact on team dynamics and the timely escalation of unwell patients. In a large district general hospital setting, we found that separating the acute take from the inpatient ward handover enhanced both time efficiency and task prioritisation. Additionally, incorporating the ICU/CCOT team into the night medical handover was widely regarded as a positive change, particularly in fostering collaborative communication and early patient escalation. This project demonstrates that simple adjustments to handover structure can enhance team dynamics and improve patient care, and offers a model that can be implemented across other hospital trusts. |
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| ISSN: | 2514-6645 |