Mind The Weekend Gap: Handover Challenges In Older Patient Care In A Model Three Hospital

Abstract

Background Clinical handover in geriatric medicine is particularly challenging due to the multifaceted needs of older patients, complex decision-making, and the importance of continuity across care transitions. In many Irish Model Three Hospitals, the current system – where on-call teams facilitate weekend inpatient reviews – introduces further challenges for safe handover. Handwritten weekend review proformas are commonly utilised, though their content may not consistently meet comprehensive handover standards as outlined by the Health Service Executive (HSE). This study audited the content of weekend handover proformas in a Model Three Hospital, against the HSE-recommended handover criteria. Methods A retrospective review of 90 weekend handover proformas was conducted over a two month period, assessing compliance with recognised HSE safe handover standards. Results The mean age of patients listed for weekend review was 74 years. Three patient identifiers were documented in 87% of proformas, while 8% lacked any identifiers. The nature of the requested review was specified in 76% of cases, with combined review of blood results and clinical assessment being the most frequently requested review modality (63%). A proposed management plan was documented in 63% of proformas, and outstanding tasks were noted in 51%. A treatment escalation plan was included in only 25% of entries, and resuscitation status was recorded in 24%. Notably, none of the proformas included triage categorisation, prioritisation, or urgency levels. Conclusion This audit highlights deficits in weekend handover communication within an acute Model Three hospital, particularly impacting older adults. Such deficiencies may contribute to adverse events, suboptimal outcomes and prolonged hospitalisation. We propose implementing a digital, standardised handover tool, incorporating HSE-recommended criteria to support structured, accurate and efficient clinical communication. This aligns with best practice, enhances patient safety and continuity of care through addressing the specific needs of the older inpatient population, while promoting environmental sustainability by reducing reliance on printed proformas.