Abstract Introduction Clinicians covering six older people’s medicine wards reported feeling burdened by requests for weekend review of patients without clear indications, reducing time for patient care. We aimed to standardise the process to streamline reviews, freeing up clinicians to deliver optimal care. Methods We developed a new electronic weekend handover process using existing capabilities within our electronic patient record. The COM-B behaviour change method was used with a focus group of clinicians including PAs, residents and consultants to identify targets to change behaviour. Fifteen potential tests of change were considered. Four were implemented over multiple PDSA cycles. Key changes included Mandatory documentation of review priority (1,2,3 or discharge). Clear documentation of review indication with recommended actions. Embedded mock examples of best practice to nudge behaviour. Engagement through meetings and informal senior/peer influence. We collected weekly data for four months on: patients put out for review, number lacking a clear indication, and the number missing prerequisite actions. A survey of clinicians was performed. Results The number of reviews remained stable but the number of patients with no clear indication for review decreased from 11.5 to 2.5. Respondents rated the new system at 7.72/10 globally compared to 3.2 for the old system. 78% felt that the reason they were reviewing patients was clear. 72% found prioritisation easier. 87% of users of the old system reported quicker review times—none thought it was slower. Conclusion A structured electronic system using existing capabilities, informed by behaviour change and quality improvement methodology reduced the number of patients put out without clear review by 78%. Satisfaction with the new system was high and time was released for direct patient care. Further tests of change are planned to drive further improvements in safety and quality, but existing changes have been sustained and success shared with the organisation.
Brew et al. (Sun,) studied this question.