{
  "abstract": "Background and Purpose St Bartholomew’s Hospital is the highest-volume PCI unit in the UK; over 3,000 percutaneous coronary interventions were undertaken at our facility in 2024/2020, ⅓ of these were performed in the setting of a STEMI. Patients are admitted with a variety of cardiovascular issues via several streams, such as direct ambulance conveyances, planned or emergency interhospital transfers & unselected walk-in cases. All admissions cohort onto an acute 18-bedded ward, which includes six level 2 Coronary Care Unit beds (CCU). CCU provides support for all Cardiology subspecialties within St Bartholomew’s Hospital. The high turnover of acute, potentially unstable cases combined with dynamic, bidirectional transfer of complex patients between the CCU & acute/stepdown wards presents significant challenges in sharing information between teams. This risk was highlighted during internal patient safety reviews. A working group was formed to improve the handover processAim Establish formal, multi-disciplinary handover meetings within Interventional Cardiology to facilitate the transition of care between teams and maintain safe clinical oversight. Establish a process that enables >70% attendance across all professional groupsMethods Staff surveys were conducted to establish baseline handover practices. Other than at 08:00, there were no formal handover meetings. Doctors would inconsistently handover in separate silos according to grade. Handover between the ward/on call teams occurred in only 40% of shift changes, handover from the Ward SpR to the evening on call SpR occurred on only 50% of occasions.A new formal, structured, multidisciplinary handover process was implemented in February 2020, based on the Royal College of Physicians Handover Toolkit. Three daily multidisciplinary handover meetings were established (08:00, 17:00, 20:00) requiring attendance from doctors, nurses, & ACPs. A meeting agenda was formalised to not only streamline the sharing of clinical information for patients moving between the care of teams across the wards but would also require discussion of the unwell patients across the Interventional Cardiology beds as well as a full handover of patients within the CCU. Designated meeting locations were determined according to the key shift changes, with the morning and night-time handover at 08:00 & 20:00 taking place on the acute ward & the 17:00 handover meeting occurring on the stepdown ward due to the end of the duty hours for the ACPs in this area. This helped establish ownership of the patients with the covering on-call teamThere were clear definition of on-call team roles and responsibilities. QR code sign-ins were employed to track attendance & to share the agenda for the meetings, thus ensuring consistency in structure. Medical staff attendance was improved by utilising regular handover project updates via email; this was used as an opportunity to recognise individuals who had the highest handover attendance & praise high-performing staff groups. The project was introduced in Oct 2024 through the Model for Improvement & iterative Plan-Do-Study-Act cycles, with progressive refinement of meeting times, content & participation logistics. Implementation was phased over several months, allowing feedback-driven adaptationResults Handover attendance improved dramatically over a 12-month period. Initially, attendance was as low as 43% in Registrars covering the ward & 67% for the Night on call team. ACP attendance was as low as 20%. This improved significantly to the point where weekly attendance levels were consistently ≥80% for nearly all professional groups ( figures 1,2). Examination of handover quality revealed that on-call teams were not being routinely notified of elective admissions to the step-down ward, this was rectified with a change to the elective admission process. The frequency of reminder/update emails was tapered over the duration of the project without detriment to the handover attendance levels or the frequency of QR Code completion. Feedback was collected through staff surveys/informal discussions & was reviewed regularly at the working group meeting. Handover quality was monitored closely: unwell patients are discussed in >99% of meetings with outstanding jobs discussed in >91% of meetings. 77% of OOH calls are for unforeseeable issuesConclusion Structured, multidisciplinary handover processes are essential for maintaining patient safety in a high-volume acute care setting with complex patient flow requirements. Establishing regular multidisciplinary handover meetings with a clear agenda ensures continuity of care and clear lines of responsibility. Recognition and communication such as regular update emails to the multidisciplinary team with positive reinforcement through acknowledgement of high-performing individuals can profoundly influence behavioural changeAbstract 558 Figure 1Attendance at handover meetings (08:00/20:00)Abstract 558 Figure 2Attendance at handover meetings (17:00)",
  "authors": [
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Ramsay Tabbara"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Yasmine Jafari"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Hawazen Alherbawi"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Mohamed Mohamed"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Elizabeth Moore"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Jennifer Mather"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Stephen-Mark Hamshere"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Daniel Jones"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Vivienne Monk"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Fizzah Choudry"
    }
  ],
  "title": "558 Improving patient safety in a high-volume system: implementing a dynamic, multi-professional handover process within interventional cardiology at St Bartholomew’s hospital",
  "uid": "5afd6068-00e0-58f6-915f-be03cc6da414"
}