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The organization that set the rules for US physicians’ hospital training has overturned a 2011 rule that restricted first year doctors to shifts no longer than 16 hours. From 1 July, new medical graduates may work shifts as long as 24 hours at a time, plus four hours more to achieve a proper patient handover if necessary, say new rules drawn up by the Accreditation Council for Graduate Medical Education. The rule change will apply throughout the US. The total weekly limit of working hours will remain at 80 hours. Stan Ashley, a surgeon at Brigham and Women’s Hospital in Boston, who chaired the committee that …

This is a multi-language (ML) update of the CLAS App original design by Bridget Maher from the School of Medicine at University College Cork, Ireland. The current version has an improve counting mechanism and has been translated from English to Spanish, Catalan and German languages within the European project PATIENT (www.patient-project.eu). The CLAS App ML aims to train good written communication skills as they are essential to the practice of medicine and avoidance of medical error. The hospital discharge letter is probably the most important of all written communications between hospital and General Practitioner (Family Doctors). However, discharge letters vary greatly in quality, structure, cohesion, and ‘readability’. Most discharge letters are written by junior doctors and frequently omit important information. The School of Medicine at University College Cork developed a comprehensive check-list i-phone application to improve the quality of hospital discharge letters. The CLAS scale lists the key elements of a discharge letter - reason for admission, investigations, results, diagnosis, problem list, medications, management plan, name and contact details of doctor writing the letter etc. There are 4 pages of items, divided into various sections. Either a section heading or an individual item can be ticked. Most items score 1, but some items of particular importance, such as medication, score higher. Total CLAS score is 50. At the end, the user is shown his total score and can swipe to see a list of unchecked items. By using the CLAS application as a point-of-practice reference tool, doctors and medical students can improve their letter-writing skills, decrease the risk of medical error and improve patient safety. With the new version CLAS App ML we aim to provide a standard within Europe for the structure of hospital discharge letter. Therefore, the App has been translated to 3 new languages.

Optimal care of patients with complex congenital heart disease requires multidisciplinary collaboration and clear communication amongst team members on all levels and between all disciplines. Multidisciplinary case conferences, daily rounding communication, and the cardiac care center leadership structure are all opportunities to maintain communication. Accurate and efficient handovers are also essential to preserving this communication and collaboration. The handovers from the operating room to the cardiac intensive care and from the nursing unit to hospital discharge are two especially important transitions of care in pediatric cardiac care centers.

Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment).Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

Personal digital assistants can provide a portable, integrated platform for point-of-care clinical reference, patient management and data communication. Clinical reference programs allow the user to access information from the Internet and guidelines. Patient management programs allow doctors to access and store clinical information. Wireless technologies have potential for rapid exchange of clinical laboratory results and efficient "electronic patient handovers". Thus, these devices provide the potential for true continuity of care across the healthcare system.

Continuity of patient care in the intensive care unit is dependent on reliable and accurate handover. The introduction of shift working for junior doctors as a result of the working time directive has resulted in a minimum of two handovers between medical staff in each 24-hour period. Structure and method of handover has been shown to critically influence the transfer of clinical information vital to the continuity of patient care. We conducted a telephone survey of the intensive care units in the north-west of England to establish details surrounding the methodology of handovers which are currently being used. We established that handovers in our region are generally occurring in a structured manner, but that the quality of handover, information transmitted and personnel present is varied. We advocate the use of a computer-based handover sheet to increase the accuracy of the handover process.

Since the introduction of shift systems for junior doctors as part of the European Working Time Directive, different teams of doctors look after patients over the course of a day. This requires ro bust handover mechanisms to pass on inf ormation between differ ent teams of doctors to avoid misses and near-misses in patients' care. Modernising Medical Careers shortens the placements of doctors in foundation programmes in general surgery to four months compared with six-month placements as pre-registration house officers in the past. The reduction in working hours will therefore adv ersely aff ect exposur e and experience of junior doctors in general surg ery unless the learning potential of time spent at work is maximised.

Background Medical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a ‘Plan, Do, Study, Act’ cycle model for improvement to address this issue. Method P – Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D – Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit. Results S – Study: Measurements were repeated 3 months later and showed no change in the primary end points. A – Act: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover. Conclusions: Using a ‘Plan, Do, Study, Act’ business improvement tool helped to improve patient care.

Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

Hospital discharge often faces breakdowns in information, communication, and coordination. The European Union FP7 Health Research Programme commissioned the European HANDOVER Project in 2008, a three year, 3.5 million Euro programme to examine transitions of patient care from the hospital to the community care settings. Six European countries--Italy, the Netherlands, Poland, United Kingdom, Spain, and Sweden--participated in this collaborative study.This paper highlights a multi-centre, multi-national research programme. We describe how HANDOVER participants conducted an 'artefact analysis' as one element of the mixed methods study to inform opportunities to make patient handovers between hospital and community care more effective.The artefact analysis consisted of a four-step process to assess different tools used in communication and treatment and their effects on the communication processes between the hospital and general practice settings.Four themes emerged from our analysis: (a) The inpatient care of a patient is 'hospital centric' whereby the hospital 'pulls' information regarding a patient's family physician (b) There are rich cognitive artefacts that support the patient clinician encounter; c) The use of information technology does not necessarily improve the communication process; and (d) There is a role for the patient, albeit not particularly well-defined or explicit, as a conduit for essential information communication.Cognitive artefact analysis is an innovative method to provide insights into transitions of patient care. It may be most useful to think about interventions at both the individual patient and the system levels that more fully address and overcome the system issues at work.

Background The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills. Objective We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills. Methods Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters. Results All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P Conclusions A brief educational workshop promoting standardized handovers improved the inclusion of essential information during intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.

BACKGROUND: During one hospital stay, a patient can be cared for by five different units. With patient transfer from one unit to another, it is of prime importance to convey a complete picture of the patient's situation to minimise the risk of medical errors and to provide optimal patient care.OBJECTIVE(S): This study was designed to test the hypothesis that the implementation of a standardised checklist used during verbal patient handover could improve postoperative data transfer after congenital cardiac surgery.DESIGN: Prospective, pre/postinterventional clinical study.SETTING: Cardiac centre of a university hospital.PATIENTS: Forty-eight patients younger than 16 years undergoing heart surgery.INTERVENTIONS: A standardised checklist was developed containing all data that, according to the investigators, should be communicated during the handover of a paediatric cardiac surgery patient from the operating room to the ICU.MAIN OUTCOME MEASURES: Data transfer during the postoperative handover before and after implementation of the checklist was evaluated. Duration of handover, number of interruptions, number of irrelevant data and number of confusing pieces of information were noted. Assessment of the handover process by ICU medical and nursing staff was quantified.RESULTS: After implementation of the information transfer checklist, the overall data transfer increased from 48 to 73% (P

Safe and effective patient handovers remain a global organisational and training challenge. Limited evidence supports available handover training programmes. Customisable training is a promising approach to improve the quality and sustainability of handover training and outcomes.We present a Handover Toolbox designed in the context of the European HANDOVER Project. The Toolbox aims to support physicians, nurses, individuals in health professions training, medical educators and handover experts by providing customised handover training tools for different clinical needs and contexts.The Handover Toolbox uses the Technology Enhanced Learning Design Process (TEL-DP), which encompasses user requirements analysis; writing personas; group concept mapping; analysis of suitable software; plus, minus, interesting rating; and usability testing. TEL-DP is aligned with participatory design approaches and ensures development occurs in close collaboration with, and engagement of, key stakeholders.Application of TEL-DP confirmed that the ideal formats of handover training differs for practicing professionals versus individuals in health profession education programmes. Training experts from different countries differed in their views on the optimal content and delivery of training. Analysis of suitable software identified ready-to-use systems that provide required functionalities and can be further customised to users' needs. Interest rating and usability testing resulted in improved usability, navigation and uptake of the Handover Toolbox.The design of the Handover Toolbox was based on a carefully led stakeholder participatory design using the TEL-DP approach. The Toolbox supports a customisable learning approach that allows trainers to design training that addresses the specific information needs of the various target groups. We offer recommendations regarding the application of the Handover Toolbox to medical educators.

Item does not contain fulltext BACKGROUND: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care. PURPOSE: To systematically review interventions that aim to improve patient discharge from hospital to primary care. DATA SOURCES: PubMed, CINAHL, PsycInfo, the Cochrane Library, and EMBASE were searched for studies published between January 1990 and March 2011. STUDY SELECTION: Randomized, controlled trials of interventions that aimed to improve handovers between hospital and primary care providers at hospital discharge. DATA EXTRACTION: Two reviewers independently abstracted data on study objectives, setting and design, intervention characteristics, and outcomes. Studies were categorized according to methodological quality, sample size, intervention characteristics, outcome, statistical significance, and direction of effects. DATA SYNTHESIS: Of the 36 included studies, 25 (69.4%) had statistically significant effects in favor of the intervention group and 34 (94.4%) described multicomponent interventions. Effective interventions included medication reconciliation; electronic tools to facilitate quick, clear, and structured summary generation; discharge planning; shared involvement in follow-up by hospital and community care providers; use of electronic discharge notifications; and Web-based access to discharge information for general practitioners. Statistically significant effects were mostly found in reducing hospital use (for example, rehospitalizations), improvement of continuity of care (for example, accurate discharge information), and improvement of patient status after discharge (for example, satisfaction). LIMITATIONS: Heterogeneity of the interventions and study characteristics made meta-analysis impossible. Most studies had diffuse aims and poor descriptions of the specific intervention components. CONCLUSION: Many interventions have positive effects on patient care. However, given the complexity of interventions and outcome measures, the literature does not permit firm conclusions about which interventions have these effects. PRIMARY FUNDING SOURCE: The European Union, the Framework Programme of the European Commission.

Background Loss of information occurs frequently during handover and affects the continuity of care. Improving handovers is therefore a key patient safety goal. After surgery, the patient is transferred to the postanesthesia care unit (PACU), and handover to the nurse includes both handover of monitoring equipment (connecting electrocardiogram, calibrating arterial lines, infusion pumps, etc.) and patient/procedure-specific information. Multitasking is likely to increase the risk of information loss during handover. It is unknown to what extent the transfer of equipment and information occurs simultaneously or sequentially in daily practice. Methods A nationwide questionnaire on the subject of patient handover was returned by 494 health care practitioners concerned with handovers from operating room (OR) to PACU. In addition, 101 handovers from the OR to the PACU were videotaped in 2 academic hospitals (n = 20), 3 teaching hospitals (n = 43) and 1 community hospital (n = 38). The occurrence of simultaneous or sequential transfer of equipment and information was recorded by two independent observers. Results Simultaneous handover of equipment and information was the preference for a minority of respondents to the national survey (11%, 95% confidence interval, 8% to 14%). Self-reported simultaneous handover was 43% (39% to 47%). In the videotaped handovers, simultaneous handover was used for 65% (56% to 74%), which was even higher in the academic centers. The simultaneous handovers were no more than 0.2 minute faster than sequential handovers (P = 0.38). Conclusions In most videotaped handovers from OR to the PACU, there was simultaneous transfer of equipment and information. Although most health care providers are unaware of it, this form of multitasking during patient handover in the PACU is common. Future studies should evaluate whether this multitasking also leads to loss of critical patient information and reduced patient safety.

Background Handover of patient information represents a critical time period during a patient's hospitalisation. While recent guidelines promote standardised communication during these patient care transitions, significant variability in structure and practice persists among hospitals and providers. Methods The authors surveyed internal medicine residents regarding handover practices before and after introduction of a structured, web-based handover application. The handover application standardised patient data in a format suitable for both patient handovers and day-to-day patient management. Results A total of 80 residents were surveyed prior to the intervention (80% response rate) and 161 residents during the intervention (average 68% response rate for all surveys distributed). At baseline, residents perceived deficits in handover practices related to the variability of information transferred and correlated that variability to near-miss events. After introduction of the handover application, 100% of handovers contained an updated problem list, active medications, and code status (compared to

Background Patient handover taking place between the Children’s Emergency Department (CED) and the ward to which the patient is being transferred is essential for patient safety. Poor or incomplete information can delay care, lead to confusion or, occasionally, lead to disastrous consequences. It is the duty of every doctor to ensure good handover takes place. It is important to optimise communication of critical information as an essential component of risk management and patient safety. Therefore we aim to assess the prevalence of patient handover taking place and the content of this being recorded in the notes. Method Fifty-four sets of notes of patients admitted to the wards from CED in October 2012 were randomly selected and audited against the following standards with 100% target for all: Written record of handover in the notes either by use of handover stamp, freehand notes entry or using handover sheet; clearly documented name of doctors giving and accepting handover; handover should be timed, dated and signed; good guality of handover using SBAR or similar format to convey information concisely (a minimum of a background, recent clinical observations and clear recommendations). A new handover document was then introduced in combination with a programme to educate and raise awareness among staff and then handover was re-audited with fifty-one sets of notes. Results Conclusion The introduction of a new handover document increased the frequency of documentation and quality of handover, thus improving patient safety. Further work is required to increase the frequency of recording the doctors involved in handover and timing, dating and signing the document. Work on further updating the handover document is underway and this will be re-audited after it is introduced.

Background The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists. We present a closed-loop audit of handover practice to assess whether standardised proformas improve clinical data transfer between shifts during handover in our Orthopaedic Unit. Methods We collected data handed over between shifts for a period of one week at our department. The data were in the form of hand written data on plain paper used to assist verbal handover. Data were analysed and a standardised handover sheet was trialled. After feedback from juniors the sheet was revised and implemented. A re-audit, of handover data, was then undertaken using the revised standardised proforma during a period of 1 week. Results Forty-eight patients were handed over in week 1 while 55 patients were handed over during re-audit. The standardised proformas encouraged use of pre-printed patient labels which contained legible patient identifiers, use of labels increased from 72.9% to 93.4%. Handover of outstanding jobs increased from 31.25% to 100%. Overall data handed over increased from 72.6% to 93.2%. Handover of relevant blood results showed little improvement from 18.8% to 20.7% Conclusion This audit highlights the issue of data transfer between shifts. Standardised proformas encourage filling of relevant fields and increases the data transferred between shifts thereby reducing the potential for clinical error cause by shift patterns.

The emergency department intershift transfer of patient care is a universal event. Despite the frequency of its occurrence and complexity of issues surrounding the exchange, emergency department patient handover is insufficiently explored in our literature. This article reviews the effectiveness and efficiencies of the handover practice. The authors provide personal opinion regarding favorable parameters for the prehandover, intershift meeting, and posthandover activities.

Introduction Improving efficiency in healthcare delivery while maintaining patient safety is central to providing high quality patient care, improved patient satisfaction and creates a culture of improved training for future paediatricians. Poor communication during patient handovers has been cited as being one of the most dangerous interventions that clinicians put patients through. The SBAR handover tool has been recognised by the WHO as well as the National Health Service Institute of Innovation and Improvement as a simple and standardised tool that encourages the clinicians to present patient information in a concise and focused fashion that has been shown to improve patient safety. SBAR is an acronym which stands for Situation, Background, Assessment and Recommendation. Aim To evaluate the impact of time spent by paediatric trainees on the morning patient handover before and after the introduction of SBAR within the department. Method The handovers involved discussing patients who were on the ward, the ED department, and ambulatory unit. An additional note was made of patients for whom there was a significant psycho-social element to their handover. Information on the time spent discussing each patient using a conventional, semi-structured handover process, was recorded for 7 days (over two consecutive weeks). This was followed by conducting the exercise again after the entire department had undergone SBAR training and a 2 month period of daily practise. Data was then gathered for a 14 day period over three consecutive weeks. Results Prior to commencing the use of SBAR, each handover was taking an average of 55.7 min (range 40 to 73) with 22 patients being discussed per handover on average. Post SBAR, it took an average of 32 min for each handover (range 19 to 49) with 21 patients being discussed per handover. Pre SBAR, it took an average of 2.57 min to handover a patient compared to 1.54 min post SBAR. This represents a 60% reduction in time using SBAR (p Conclusions This significant reduction in handover times using SBAR demonstrates improved efficiency. This has several benefits including enabling time to be generated for ‘micro-teach’ sessions and improved paediatric training or increasing departmental productivity.

Objectives—The aim of this study was to examine the quality of handover of patients in the resuscitation room by describing the current perceptions of medical and ambulance staff. Methods—This was a descriptive survey using two anonymous questionnaires to gauge current opinion, one designed for medical staff and the other for ambulance staff. Questionnaires were distributed to medical staff in two teaching hospital accident and emergency (A&E) departments and ambulance personnel in the Tayside region of Scotland. Results—30 medical and 67 ambulance staff completed questionnaires. Some 19.4% of ambulance staff received formal training in giving a handover, 83% of the remaining felt there was a need for training. Medical staff conveyed their belief that handovers were very variable between crews and that they did not feel radio reports were well structured. Ambulance crews felt that medical staff did not pay attention to their handovers. Ambulance staff seemed satisfied with the quality of their handovers, although medical staff were less positive particularly in the context of self poisoning and chest pain. Both seem to be least confident with regards to the handover of paediatric emergencies. Medical staff were generally less satisfied with the reporting of vital signs than the history provided. Conclusions—Despite a generally positive perception of handovers there may be some room for improvement, in particular in the area of medical emergencies. Ambulance staff training should produce a structure for the handover that is recognisable to medical staff. The aim being a smooth and efficient transfer from prehospital agencies to A&E staff.

The Royal College of Physicians state that ‘handover, particularly of temporary ‘on-call’ responsibility, has been identified as a point at which errors are likely to occur’ [1]. Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors, with added pressure in trying to identify patients and tasks amongst several different pieces of paper and making important care escalation. All handover sheets from a random weekend were collected and studied. Only 57% of patients listed had the minimum expected 3 patient identifiers [2] included and just 11% had any indication of escalation planning. They were also often written on scrap pieces of paper and included varying levels of relevant patient background and information. After liaison with junior doctors and the handover committee, involving senior medical clinicians, a new handover sheet was created and uploaded onto the trust intranet, to rectify some of the problems identified. Junior doctors were also educated about the changes to weekend handover. At 2 months post-introduction, another set of weekend handover sheets were collected. All medical wards used the handover sheets for documentation of patients and tasks at a weekend and inclusion of 3 patient identifiers rose to 80%. There was also a big increase noted in clinical information and background included at weekend handover and anecdotally made weekend handover easier and less stressful. There was also increased consideration of escalation planning. The handover sheet is now being rolled out trust-wide in medicine and introduced to surgical colleagues.

TheintroductionofEuropeanwork-ingtimedirectiveshascreatedashiftpatternofwork.Thishasresultedintwicedailyhandoverbetweenteamswhichformsavitalpartofthecontinuationofsafeandeffectivepatientcen-tred care. A good quality handover will be aimed to improvepatient safety, reduce the risk of errors and encourage juniordoctors to achieve best practice.Many maxillofacial junior doctors are newly qualifiedwith limited exposure to hospital based handovers and areoften involved in caring for multiple patients with complexmedical and surgical needs. The aim of the audit was toimprove the overall content of the handover.

The European Working Time Directive and economic challenges have led to a paradigm of shift-work becoming common, and yet the continuation of high-quality patient care remains paramount. Effective and safe transfer of clinical information is critical as emphasised by the Royal College of Surgeons document ‘Safe handover: Guidance from the Working Time Directive working party (March 2007)’. The aim of this project was to design and implement a handover proforma in order to deliver a more efficient and safer system for patient care over the weekend. The surgical weekend handover proforma was designed following consultation with nursing and medical colleagues. It included a traffic light scoring system to alert the on-call team of the urgency of clinical review. An educational session was delivered to junior doctors on the surgical rotation to ensure accurate completion of the proforma. All trainee surgical doctors from Foundation Year 1 to Specialist Registrars were asked to complete a pre- and post-intervention questionnaire. Improvement was noted in all categories measured. 85% of the firms were using the new surgical weekend handover sheet. 78% of junior doctors were confident in understanding the patient's condition and executing the clinical jobs faster, with ward rounds lasting less than 3 hours. On average, 20% of patients were discharged per weekend during the trial period. Robust patient handover is vital to maintain patient safety and avoid adverse events. Our findings support the use of a surgical proforma to provide a consistent and structured approach to inpatient handover during the weekend.

Patient handover is an important part for information transfer between medical professionals in a clinical setting. Yet, in current medical education, these conversations are only trained sparsely, since they are costly to perform as they take place in offsite courses and are led by experts over several days. Virtual reality (VR)-based training courses could increase the availability of training, by eliminating travel costs and reducing the time-commitment of the teaching experts. This work presents a VR prototype of a multi-user training and examination application for patient handover. To ensure a similar interaction quality to its current real world counterpart, this work used omni-directional video recordings to create a realistic setting and compared different projection methods. A pilot study highlighted distinct use-cases of sphere and mesh projections to visualize the recordings. The results suggest enhanced spatial presence relating to the usage of omni-directional videos in VR-applications.