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Developing a New Flexible Tool for Handover.

BACKGROUND
Transferring medical information among professionals and between shifts is a crucial process, allowing continuity of care and safety, especially for complex patients in life-threatening situations. This process, Handover requires focusing on specific, essential medical information while filtering out redundant and unnecessary details. The objective of this paper was to create and implement a tool for handover that would be flexible enough to meet the unique needs of specific departments.


METHODS
We used PDSA to prospectively develop, implement, evaluate and reassess a new handover tool in a 900-bed teaching hospital in central Israel. Nurses in 35 departments participated in developing a tool that presents the staff's viewpoint regarding the most critical information needed for handover.


RESULTS
A total of 78 nurse managers and 15 doctors (63.7%) completed the questionnaire. Based on Exploratory Factor Analysis, 15 items explained 58.9% of the variance. Four key areas for handover were identified, in addition to basic patient identification: 1) Updated clinical status, 2) Medical information, 3) Special clinical treatment, and 4) Treatments not yet initiated. Subsequently, a Flexible hAndover Structured Tool (FAST) was designed that identifies patients' needs and is flexible for the specific needs of departments. Revisions based on hands-on experience, led to high nurse satisfaction with the new tool in most departments. The FAST format was adopted easily during the COVID-19 pandemic.


CONCLUSION
Implementing a new handover tool-FAST was challenging, but rewarding. Using PDSA methodology, enabled continuous monitoring, oversight, and adaptive corrections for better implementation of this new handover reporting tool.