Improving availability and accuracy of the junior doctors' on-call handover through digitalisation.

Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables the day team to effectively prioritise and follow-up any necessary tasks.Junior doctors at a hospital site in the London Borough of Newham were aware that the existing handover system, constituted of a word document circulated via email, was lacking robustness and that the handover was not sent out reliably on a daily basis.Quality improvement (QI) methods including process mapping, PDSA ('Plan, Do, Study, Act') cycles, driver diagrams and run charts were used to understand the issue, create a more robust process and measure the improvements made, all supported by regular QI project meetings. The change ideas included moving from an informal Microsoft (MS) Word document, which was emailed out, to an Excel spreadsheet stored centrally on MS Teams. Column headers were added for admissions, ward jobs, seclusion reviews, matters relating to mental health law and Accident and Emergency (A&E) assessments, as well as defined columns for outstanding jobs and standard tasks that need to be completed for all admissions. Responsibility for circulating the handover list was given to the incoming day duty doctor if the night doctor was too busy, with admin support to chase the circulation of the handover. Results were studied for the following 18 months.The percentage of handovers being appropriately sent out increased from a median of 80% to 100% during the project period, and the availability of handover data where the data were visible to doctors on MS Teams but had not been sent out also increased from a median of 80% to 100%. The system was deemed safe, effective and easy to use, and has already been replicated at neighbouring hospitals.

AMU patient list generation: from junior scribe to junior doctor.

This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The AMU patient list categorises patients requiring 'clerking', 'post-take' (PTWR) and 'post-post-take' (PPTWR) for the morning ward round. During weekdays, this list need only include the patients in AMU. For weekends, this list must include 'outliers', that is, patients transferred to different wards (which may lack resident medical teams over the weekends) but still requiring PTWR/PPTWR. The list is created by the junior doctor on their night shift, a daily necessity due to the high AMU patient turnover.A pilot study, followed by three complete 'plan-do-study-act' (PDSA) cycles, was conducted over 2021/2022. Cycle 1 (pre-intervention) and cycle 2 (post-intervention) assessed the impact of the generator on weekdays. This was adapted for the weekend over cycles 2 and 3. The process measure assessed was the time taken for list generation. The outcome measure was the total number of patients clerked per night. The balancing measure was doctors' attitudes.The intervention reduced the time taken for list generation by an average of 44.3 min (66.3%) during weekdays and 37.8 min (42%) during weekends. Run charts demonstrated significance for the reduction in weekday list generation time. Both weekdays (63.5% decrease, p<0.00001) and weekends (50.5% decrease, p=0.0007) had significant reductions in total negative attitudes. Both weekdays and weekends had 'time-consuming' as the most frequently selected attitude pre-intervention, whereas 'easy to make' was most frequently selected post-intervention. Some junior doctors reported the generator enabled clerking of extra patients, supported by non-significant increases in the averages for this outcome.This QIP demonstrates how the automation of labour-intensive administrative tasks results in notable time-saving outcomes. Thereby improving doctor attitudes and well-being, and facilitating the delivery of quality patient care.