gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

02. - 06.09.2018, Osnabrück

First steps towards an implementation of a structured medical handover protocol in a neurological intensive care unit

Meeting Abstract

  • Bogdan-Andrei Ianosi - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik., Hall in Tirol, Österreich; Medical University of Innsbruck, Neurological Intensive Care Unit, Innsbruck, Österreich
  • Werner Hackl - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik., Hall in Tirol, Österreich
  • Lukas Huber - Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Austria, Innsbruck, Österreich
  • Raimund Helbok - Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Austria, Innsbruck, Österreich
  • Elske Ammenwerth - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik., Hall in Tirol, Österreich

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 63. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Osnabrück, 02.-06.09.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocAbstr. 150

doi: 10.3205/18gmds069, urn:nbn:de:0183-18gmds0699

Published: August 27, 2018

© 2018 Ianosi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Ineffective communication is a well-recognized risk for patient safety [1]. The most frequent and significant communicative process between clinicians is the clinical handover [2]. This process is extremely important on the intensive care unit (ICU), where decisions have to be promptly made. On top of that, neurocritical care units (NICU) are well known producers of large amount of patient related data [3]. We aim to characterize a unstructured handover on a NICU and based on these results to implement a structured protocol.

Materials and methods: We observed the clinical handover between night-shift and day-shift on a NICU of a tertiary hospital in Austria for 1 month. The individual issues discussed as well as the categories they appertain to per patient, number of participants in the handover, day of the week and duration of the handover have been prospectively collected. Based on this data and after consultations with the medical direction of the NICU, a structured protocol has to be developed and employed. The medical direction will determine the importance of categories that have to be discussed during the handover through the Delphi method. The 5 most important categories will be determined and a checklist approach will be implemented. An analysis of duration of the handover, total number of items and number of items discussed per patient as well as a process mining analysis using Disco 2.2.0 will be performed.

Results: During the handover there were 3 specialists [IQR 2-3.5] and 3 residents [IQR 2.5-4] present. The median number of patients present was 16 [IQR 14.5 - 16]. The median duration of the handover was 42 minutes [IQR 21.5 to 50] and 82 items [IQR 38.5 -93] were discussed. A median of 4 [IQR 2-8] items were discussed per patient. We identified 282 individual problems discussed and grouped them into 29 categories. The top 5 categories most often mentioned were in order: “Clinical development”, “Medical history”, “Clinical signs”, “Inflammation parameters” and “Imaging”.

Discussion: We aimed firstly to characterize an unstructured handover on a NICU. This is very important as the abundance of clinical, imaging, neuromonitoring, hemodynamic and pharmacological data might seem overwhelming and complicated to structure and summarize. We have identified a significant variability in duration of handover (range 8 minutes to 50 minutes), items discussed per patient (range 1 to 17) and categories mentioned. This is important for the organization of the NICU and planning of a handover free of deviations and repetition. Based on this data and preferences of medical direction, through a structured hand-over protocol we aim to improve communication between physicians and make the handover protocol more overarching and representative for all patients. Furthermore this could constitute the basics for developing logical and mental maps between categories and items discussed (i.e. “Inflammation parameters” <–> “Antibiotics” <->“Infection”), serving as the first step towards a automatic generated handover list which could improve the accuracy of the information transmitted.

This work takes place within the PATIS-Project (A PATient safety Intelligence System and framework for the secondary use of multimodal clinical data to assess and improve patient safety) which is supported by the Austrian Science Foundation (FWF – P 29076).

The authors declare that a positive ethics committee vote has been obtained.


References

1.
Leonard M, Graham S, Bonacum D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13:85-90
2.
Eggins S, Slade D. Communication in Clinical Handover: Improving the Safety and Quality of the Patient Experience. J Public Health Res. 2015 Dec 17;4(3):666.
3.
Flechet M, Grandas FG, Meyfroidt G. Informatics in neurocritical care: new ideas for Big Data. Curr Opin Crit Care. 2016 Apr;22(2):87-93.