• Vishal Luther, Daniel Hammersley, and Ahmed Chekairi.
• Cardiology ST4 in the Department of Cardiology and General Medicine, Ealing Hospital, Middlesex.
• Brit J Hosp Med. 2014 Jan 1; 75 (1): 44-7.

BackgroundMedical admission units are continuously under pressure to move patients off the unit to outlying medical wards and allow for new admissions. In a typical district general hospital, doctors working in these medical wards reported that, on average, three patients each week arrived from the medical admission unit before any handover was received, and a further two patients arrived without any handover at all. A quality improvement project was therefore conducted using a 'Plan, Do, Study, Act' cycle model for improvement to address this issue.MethodP - Plan: as there was no framework to support doctors with handover, a series of standard handover procedures were designed. D - Do: the procedures were disseminated to all staff, and championed by key stakeholders, including the clinical director and matron of the medical admission unit.ResultsS - STUDY: Measurements were repeated 3 months later and showed no change in the primary end points. A - ACT: The post take ward round sheet was redesigned, creating a checkbox for a medical admission unit doctor to document that handover had occurred. Nursing staff were prohibited from moving the patient off the ward until this had been completed. This later evolved into a separate handover sheet. Six months later, a repeat study revealed that only one patient each week was arriving before or without a verbal handover.ConclusionsUsing a 'Plan, Do, Study, Act' business improvement tool helped to improve patient care.

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