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56 Hospital at night; setting up from scratch and building sustainability and success in a paediatric teaching hospital
  1. Martin F Lister,
  2. Sonia Joseph
  1. Royal Hospital for Sick Children, Edinburgh, UK

Abstract

Setting 130 bedded quaternary paediatric hospital. Overnight, new admissions and all departments (excluding PICU, surgical patients and A+E) are managed by a team of 3 doctors (Foundation Doctor/GPST, paediatric ST1/2, senior paediatric registrar).

Aims • Set up a Hospital At Night (HAN) team

• Provide facilities for an effective HAN team

• Improve communication within the HAN team

• Reduce interruptions to handovers and maintain handovers within their allotted time

Methods We set up a multidisciplinary working group comprising a: consultant paediatrician, paediatric registrar, nurse manager and a nurse co-ordinator. These individuals discussed the situation with their peers and others they work with overnight (e.g., ward nurses, members of the surgical team). The working group met with other HAN teams throughout the region and discussed their processes. Several audits and ‘time in motion’studies identified specific issues which could be addressed. 48 PDSA cycles were undertaken over an 18 month period with close collaboration and communication between our project group, senior clinical management and front line teams.

Outcome Funding was obtained for a specifically adapted ‘HAN Room’which has become the team base for handovers, administrative work and breaks. An improved escalation policy for deteriorating patients has been implemented with the help of a HAN Standard Operating Procedure and ward level teaching on identifying and managing a deteriorating patient for nursing teams. Interruptions to handover have stopped (saving 10 min per handover) and now 95% of handovers occur within the allotted time. Variation from this occurs appropriately due to discussion about complex or deteriorating patients.

Conclusion We have set up a successful HAN team and provided it with appropriate facilities. By doing this we have significantly improved communication, handovers, team dynamics and the team culture.

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