18 Quality improvement project: improving the confidence of resident doctors in completing electronic tasks during changeover in a hospice setting

<h3>Background</h3> Hospices rely on rotational resident doctors to provide medical cover. Hospices often consist of a small group of rotational resident and non-rotational senior doctors. Resident doctors rotate every four to six months, and handover is essential for incoming doctors.¹ Lack of formal handover during frequent changeovers results in a loss of procedural knowledge and prevents new doctors from being immediately effective.² Additionally, it can be a time burden for non-rotational doctors to explain procedural tasks. Poor-quality handover impacts upon continuity of care, and hence patient safety.³ Reference guides improve doctors’ confidence and immediate efficiency when starting new roles.¹ <h3>Methods</h3> Resident doctors at Dr Kershaw’s Hospice completed an initial survey in July 2024. This gathered retrospective confidence levels in completing tasks using the hospice’s electronic systems within week one of the rotation, using a scale of 0 (no confidence) to 10 (extremely confident). Step-by-step processes to complete electronic tasks were collated into a guide. The guide was shared with the outgoing resident and permanent senior hospice doctors, and feedback was obtained. The guide was then shared with the incoming resident doctors. The new resident doctors were surveyed in August 2024, gathering confidence levels in completing the same electronic tasks, having used the guide. <h3>Results</h3> After implementation of the electronic system guide, mean confidence of resident doctors completing all electronic tasks within one week of rotating increased from 3.56 to 8.64. Ten out of eleven tasks showed a mean confidence increase, and seven of these increases were statistically significant (p&lt;0.05). <h3>Conclusions</h3> The implementation of the handover guide for resident doctors at Dr Kershaw’s Hospice has markedly improved doctors’ confidence in completing electronic tasks during the changeover period. There are further opportunities available for improving handover material to improve productivity and patient safety during changeover, specifically tailored to the hospice environment. <h3>References</h3> Davies M, Panchal S, Misra N. The handbook: an end to ‘I wish I had known that before I started’. <i>BMJ Qual Improv Report</i> 2015;<b>4</b>:u203210.w1579. Hayes L. Improving junior doctor handover between jobs. <i>BMJ Open Quality</i> 2014;<b>3</b>:u201125.w713. Khine CK, McCann B, Tang JW, Kynaston-Pearson F. Improving handover between medical rotations for doctors in training - a quality improvement project. <i>Future Healthc J</i> 2020 Feb;<b>7</b>(Suppl 1):s41-s42.