58\u2005Hospital at weekends: improving continuity of care

Abstract

Introduction Maintaining continuity of care at the weekends with a reduced workforce requires effective handover, and robust workforce and task management. In Medway Maritime Hospital, an audit showed that only 50–60% of the weekend handover tasks were completed. This Quality Improvement(QI) project demonstrates the value of QI tools in empowering junior doctors as change leaders. Method The scope of this QI project was defined using the Model for improvement1 (table 1).Abstract 58 Table 1 A survey of junior doctors was conducted to investigate the barriers against continuity of care at the weekends and ideas for improvement. The survey result was used to construct a Drivers diagram (figure 1), which outlined the ‘theory for change’ and identified appropriate interventions.2 The key interventions were: Week 3: Introduction of structured handover meeting Week 6: Change to weekend medical staff model to increase the number of doctors on ward cover and providing more senior support for foundation year 1 doctors Week 11: Change to medical registrar rota to enable the weekend ward registrar to lead the handover meeting Week 24: An electronic handover system was developed and piloted from week 24, with full roll out at week 28. Result At 6 months, the handover TCR improved to 88% (figure 2). The run chart showed shift, trend, and too few runs, indicating non-random variation.3 The perceived effectiveness of weekend handover showed sustained improvement from 7.4/10 to 8.7/10 in the same period. The number of weekend discharges showed only random variation.Abstract 58 Figure 1Abstract 58 Figure 2 Conclusion This QI project improved continuity of care at no additional cost to the hospital. Junior doctors are well placed to offer solutions for challenges in modern healthcare, and QI is increasingly recognised as a core skill for doctors. The Model for improvement, driver diagram, and run charts are accessible QI tools that empower doctors to deliver measurable improvement in care. References ACT Academy. Plan, Do, Study, Act (PDSA) cycles and the model for improvement. 2017.https://improvement.nhs.uk/resources/pdsa-cycles/(accessed 4 Jul 2019). ACT Academy. Driver diagrams. 2018.https://improvement.nhs.uk/resources/driver-diagrams-tree-diagrams/(accessed 3 Jul 2019). Perla RJ, Provost LP, Murray SK. The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf 2011;20:46–51. doi:10.1136/bmjqs.2009.037895