Authors (including presenting author) :
Suen SM(1), Chin A(1), Chu MK(1), Tang C(2),Ip KF(2),Chan F(2), Tong KM(3),Lam Q(3),Chan J(3), Kam J(3),Lai C(3)
Affiliation :
(1)Neurosurgery, Princess Margaret Hospital, (2)Medicine & Geriatric Unit, Princess Margaret Hospital, (3) Information Technology Department, Princess Margaret Hospital,Kowloon West Cluster
Introduction :
Clinical Handover is well-known as one of the most important elements to achieve patient safety in the healthcare system. However, there is no structured system for nurses to conduct daily clinical handover. Therefore, we have sought support from the Kowloon West Cluster(KWC) Information and Technology Department and developed a comprehensive and uniformed Patient Clinical Handover System (PCHOS) in the Situation,Background, assessments, Recommendation (SBAR) format.
Objectives :
Develop an electronic system to facilitate daily clinical handover, display health care activities in electronic dashboard, generate generic forms for follow up documentation and facilitate consultation to other parties
Methodology :
PCHOS provide a standardized template for clinical handovers and allow nurses to individualize a patient care plan. The continuity of nursing care was improved and secured after application. By using same Hospital Number as the index for information transfer, nursing operations have been more efficient on consultations with other specialties such as Community Nursing Service(CNS). With a single button, appropriate information can be transferred to other parties directly. Moreover, the system has other features including the ability to generate generic forms for nurses to perform follow up documentation. The amount of miscommunication was significantly reduced with essential information shared.In addition, selected health care activities can be displayed on the departmental electronic dashboard (e-Whiteboard) for easy communication between health care teams. Patient's bed numbers with preset information can be displayed automatically on the e-Whiteboard after setting. By linking up with hospital Clinical Information Systems(CMS), no additional input is required during the bed movement of patients. Simply, patient information can be well utilized in information sharing during the whole patient journey from clinical handover, daily care documentation, dashboard displays to interdepartmental consultation. In summary, PCHOS is a comprehensive solution for improving communication of patient care-related information between health care providers and can be further generalized to be multidisciplinary integrated clinical information system for entire hospital.
Result & Outcome :
The program was piloted in Neurosurgery and Medicine&Geriatric Department since Nov 2017 and was well accepted by frontline staff. The program was then rolled out to other departments with fully implementation (except Intensive Care Unit) in Princess Margaret Hospital. Its acceptability and flexibility were proved again while the program was adopting in psychiatric setting of Kwai Chung Hospital and rehabilitation setting of Lai King Convalescent wards in 2018, and subsequent deployment was in progress in North Lantau Hospital, Caritas Medical Centre and Yan Chai Hospital. Their iPad friendly design also facilitated the handover in paperless format. As of Jan 2020, PCHOS had already been deployed to 127 wards, supporting 2,000+ users. The number of Community Nursing Service(CNS) referrals was 17,000+ and total 230,000+ Hospital Cases were handled with 5 million+ transactions processed. Time used in Nursing Handover & CNS Referral Process after using PCHOS has been reduced significantly by 24534 Hours (Save 20 minutes/HN). A hospital wide evaluation survey has been done in PMH in August 2018 with 73 surveys received, the mean satisfaction score is 3.19 (2.68 – 4.88). High correlation with the overall satisfaction was found in the facilitation of daily clinical handover (0.91), enhanced consistency of nursing (0.89) and providing guidance to junior staff and new comers for identifying patient’s care focus and clinical handover (0.82). Another hospital wide evaluation survey on e-Whiteboard was conducted in June 2020 with total 143 surveys received. Near 80% staff agreed the system supported them to perform daily patient care effectively and correctly.
