The handover leader is responsible for ensuring that all management plans are followed through. Evening and weekend handovers were not audited in this study as it was important for the checklist to be completed consistently by the same individual, which was only possible for weekday morning handover. This checklist was completed on consecutive days for a period of three weeks by an impartial observer, a psychiatric doctor whose handovers were not included in the audited data.
This observer also provided useful insight regarding the degree to which handovers were concise, structured and consistent. Doctors were also required to explicitly state whether or not each case was discussed with the consultant on call, although there was no obligation to discuss every case. The intervention consisted of Training and Prompting components. The Training Intervention comprised: a a focused meeting with the Liaison Psychiatry Team to summarise the audit details and achieve buy-in; b a mandatory training session targeting the registrars on the on-call rota.
Data is entered by the assessing clinician prior to handover in the same format as verbal presentation. Self-harm nurses cross-match database entries with ED attendance records on a daily basis to ensure full adherence. Handovers were re-audited immediately following the intervention for two consecutive weeks. This was followed by a two week interval and then a third audit in order to establish stability of change.
The differences between each of the audit groups were compared using a two-tailed paired T-Test. P-Values were obtained to evaluate statistical significance. Results Baseline Handovers on consecutive weekdays over a period of three weeks were included in this part of the study. None of the cases handed over were fully compliant with the handover checklist. However, the researcher completing the checklist observed that in most cases the information was excessive and lacked the intended structure of SBAR.
Post-Intervention Audit: Immediate Immediate re-audit following implementation of the intervention demonstrated an improvement in communication of basic demographics name, age, catchment area with a modest improvement in situation and recommendation parts of SBAR.
The handovers were generally observed to be more structured and concise.
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