BULLETIN

Page 36 | Bulletin 92 | July 2015
Figure 1
Bar chart showing the frequency with which consultants would hand over specific
ASA grades of patients
department were, poor communication,
poor documentation, and omission
of important information were most
frequently cited. Other prominent
factors were information overload, lack
of written information, lack of structure
and formality and the frequency with
which the lead consultant changes.
51% felt there was not enough room
on the anaesthetic chart, with 64% of
respondents wanting a dedicated space
to document handover information and
48% of consultants feeling that a formal
structured handover policy was needed.
Figure 2
Intraoperative handover aid memoire. This is kept on each anaesthetic machine and used to
allow a structured handover
We have established that intraoperative
handover occurs regularly within our
hospital. More importantly, we have
identified a need for change and demand
for a structured handover system.
With the increasing use and acceptance
of checklist style cognitive aids,
we introduced a laminated A5-size
aide-memoire. This contains a series
of clinical headings that should be
used when handing over patients.
The cognitive aid is attached to each
anaesthetic machine in theatres. A
sticker accompanies this, which can
be attached to the anaesthetic chart,
allowing anaesthetists to date and
sign that handover has occurred. We
have used several ‘plan, do, study,
act’ cycles to gain feedback and make
improvements. This has allowed the
project to be promoted and accepted by
the anaesthetic department.
commitments for half a day and
non-clinical commitments for the
other session. This can lead to ‘all
day’ lists being covered by multiple
anaesthetists. Given this, it is
surprising that only 58% agreed that
intraoperative handover of elective
patients is acceptable.
We asked if consultants would hand
over an emergency ASA 1 stable patient,
ASA 2 etc up to an ASA 4 unstable
patient. Predictably, as the ASA score
of the patients increased, consultants
were less likely to hand over during
the case. Almost 90% of consultants
would hand over a stable ASA 1 patient
compared to 10% who would hand
over an unstable ASA 4 patient. On
investigation of our serious incident
reports, stability of the patient’s
condition and appropriateness of the
timing of handover had been an issue.
When asked what common reasons
for inadequate handovers within the
We looked at attitudes towards the
aide-memoire four months after it was
introduced. We had a lower response
rate (28 out of 105 consultants).
However, 93% of respondents were
aware of the aide-memoire and 40%
felt that it had a positive impact on
patient safety. It will be difficult
to prove that we have improved
patient safety, but the department
has an increased awareness of the
importance of good intraoperative hand
over, and over time we hope to see less
patient safety incidents related to this
aspect of care.
Our intraoperative hand over aidememoire
will be introduced as policy,