The introduction of the European Working Time Directive has led many UK hospitals to move to full or partial shift systems. The feasibility of shift systems hinges on safe and effective clinical handover.
The Department of Health's Hospital at Night report highlights clinical handover as a "critical element of the model," yet it recommends only that medical and surgical handovers should be combined, that it should be clear who is leading the handover, that all team members should attend, and that handover should take place in a dedicated room.
During 2005, researchers surveyed house officers on call in general surgery in the 17 hospitals in Wales.
In six hospitals there was no allocated place for handover, and in none of the hospitals was handover bleep-free and uninterrupted. Allocated handover time was no longer than 30 minutes in 16 hospitals and no longer than 20 minutes in 11.
Only two hospitals had developed a handover proforma, giving information such as outstanding investigations and patient reviews. Instead, personal lists were used in most hospitals, with the potential of patients being lost if lists are mislaid.
Six house officers never, and five only sometimes received feedback of their management decisions at handover. Eight of them never or rarely presented to the consultant on call.
The benefit to the patient of being treated by less tired doctors who work in shifts is offset by information breakdown due to poor handover, rendering the system prone to misses and near misses, warn the authors.
They favour a post-take bedside ward round, not only from a medicolegal point of view, but also as an opportunity for bedside teaching and learning by giving feedback to the outgoing team. And they suggest that the leadership of senior doctors in the handover process would be of great benefit.
Rotas may also need to be adjusted to allow sufficient overlap between junior doctors' shifts and senior doctors' working days, they conclude.