Setting Acute Receiving Unit (ARU) within a quaternary paediatric hospital with 8300 admissions/year.

Aim To improve handovers, job allocation and patient ‘ownership’ within the ARU.

Methods Problems and ideas were brainstormed with the ARU team identifying key themes and targets for intervention. A series of changes were implemented utilising PDSA cycles with collaborative team reviews of data to determine the next cycle intervention. Outcome measures included analysis of handover duration, quality of information and subsequent team understanding of patients needs before and after the interventions. We performed a post-implementation survey investigating staff perception and experience. The final model of handover took 12 PDSA cycles and was then formally agreed through senior clinical management teams.

Results There is a sustained reduction of the length of the post-ward round handover from 94 to 35 min (10 days analysed pre and post-intervention). A qualitative survey found the following percentages of people agreed/strongly agreed that: handover is more efficient (58%), job allocation is more robust and efficient (92%) and there is improved patient ‘ownership’ (83%: 12 respondents). In addition, the respondents unanimously felt that encouraging junior doctors to lead patient handovers with consultant supervision, in place of consultant to consultant handovers, was empowering for trainees and turned a service safety task into a training opportunity. 92% of respondents agreed that an active ‘pause’ following handover to ask questions or discuss staff and service issues was beneficial.

Conclusion Empowering junior members of the team to handover patients through a series of small changes has improved the quality of our teams care for their patients by maximising efficiency and effectiveness, as the whole team feels responsible.