This forum consisted of core medical trainees (CMTs) and the ‘Chief Resident’ (RC), supervised by the CMT Training Programme Director (JB) and other interested senior clinicians (MD and BC-K). A quality improvement (QI) forum was formed and decided to focus on improving handover quality. There was no standard location for these to be found meaning they could be lost altogether, and when found, the OOH team would have no opportunity to clarify handover content or ask questions.įollowing the national training survey results, it was decided to attempt to improve the quality of medical handover in GRI. Furthermore, downstream handovers were typed or handwritten and left on the ward for the OOH team to find. There was no agreed proforma or structure to help ensure important information about each patient was included in the handover. 1 Most handovers lacked senior supervision (ie, specialty registrar or above). In the 2017 Scottish national training survey, handover was ‘red-flagged’ as an area of concern among junior doctors across multiple medical specialties within GRI. The volume of patients in downstream wards is such that the weekend doctors have to select which patients to review based on reports from nursing staff and those patients who have been ‘flagged’ in the handover from the weekday team. It is therefore the responsibility of ward doctors during the week to leave a handover for the OOH team.
At the weekend, downstream wards are covered by an out of hours (OOH) team of junior doctors who are usually unfamiliar with the patients on the wards they are covering. On downstream wards there are morning, early evening and night-time handovers 7 days a week. Handovers between junior doctors occur twice daily on receiving wards and the acute assessment area.
The medical departments consist of an acute assessment area for direct general practitioner admissions, 5 multispecialty receiving wards (respiratory, general medicine, gastroenterology, cardiology and stroke/department of medicine for the elderly), a medical high-dependency unit and 29 downstream medical wards. Glasgow Royal Infirmary (GRI) is a large teaching hospital located in central Scotland with approximately 1000 inpatient beds.
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