APSD Chart

Medical 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.

P - 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.

S - 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.

Using a Plan, Do, Study, Act; business improvement tool helped to improve patient care.

Full text is available on: Luther V , Hammersley D , Chekairi A. Br J Hosp Med (Lond). 2014
Jan;75(1):44-7.