New health app CAREFUL helps clinical teams reduce the dangers of handover

 Thousands of patients are dying every year and hospitals are wasting up to 15% of their entire budget as a result of poor handover. The UK NHS wastes at least £250m a year from delays to discharge, and the same problem is seen in hospitals throughout the world. Healthcare start-up CAREFUL has launched its platform to help make handover safe, save lives and speed-up patient flow in hospitals by making discharges quicker to save costs and improve care.

 Handover is a critical process in healthcare when responsibility for patients transfers from one clinician or team to another. In every hospital, thousands of such handovers take place every week. Most hospitals use a combination of inefficient, informal communication systems for handover including bits of paper, sticky notes, and WhatsApp messages. 

Established in 2021, Careful has been testing and building its tech platform to enable clinicians to seamlessly capture and update health data and records of patients in hospital care. CAREFUL is a digital health platform that enables visibility, accountability and collaboration as patients move through different care settings and interact with different care-givers. The platform provides hospitals, clinicians and multidisciplinary teams with a constantly updated, holistic view of every patient’s plan of care to ensure their safe and frictionless movement throughout their health journey. 

Research from CAREFUL* shows a quarter of all doctors and nurses worldwide use spreadsheets to record lists of patients and tasks. A clear view of the status of the hospital — and predicting future flows — is obscured. Staff don’t know what’s happening and nor do the patients. Even in digitally advanced hospitals, critical tasks are regularly lost or forgotten. 

“All these headaches can be solved quickly and easily with CAREFUL” says  Dr DJ Hamblin-Brown, Founder & CEO of the company. “CAREFUL is a simple-to-use and easy-to-implement application which helps hospitals communicate internally, and also with patients and their families”. 

Dr Hamblin-Brown was motivated to build CAREFUL because his mother nearly died from a simple communication failure in a UK hospital. He adds, “Although clinicians take handover very seriously, errors still occur because staff are let down by the systems they are forced to use. With desperate shortages of clinical staff, hospitals need CAREFUL to help save money and save lives.” 

The WHO estimates that 15% of all hospital expenditure is wasted on adverse events that happen to patients – and that 80% of these are due to poor handover. This causes serious harm to patients, sometimes with fatal outcomes. Inadequate systems leave staff over-burdened and stressed, leading to resignations and burnout. Errors also cause delays. Beds are taken up by patients who should be discharged. Once at home, the problems continue. No one knows what the next steps are and patients are often lost to follow-up. Together this costs every hospital millions every year. 

Dr Johann Grunlingh, an NHS emergency medicine consultant and Intensive Care specialist in London. He and his team at Newham Hospital helped to test the application during development. He says, “Handover is a time consuming and dangerous process especially in critical care. CAREFUL fills a huge gap where Electronic Patient Record systems perform poorly. CAREFUL provides an action-focus that would benefit every care team in the NHS.”

 “CAREFUL can be up-and-running in any hospital, clinic, or care home in a matter of days”, says Dr Hamblin-Brown.  It works on mobile, tablet or desktop presenting critical information for each patient, along with task lists assigned to individuals, clarifying who needs to do what, and when. As staff change shift, and patients move through the hospital, tasks and status information move with them – even out into the community or home. As a result, patients and staff know at all times what is happening, and who is responsible.

 Roohi Hamlani, CAREFUL’s co-founder and Head of Patient Participation is passionate about extending CAREFUL’s reach into care-homes and families, from whom patients receive the majority of their care. CAREFUL’s approach was based on her work in Asia improving outcomes with collaborative care for chronic disease patients. She says better workflows are about breaking-down silos. “To provide the very best care, clinicians, families and caregivers all need to work together across boundaries. CAREFUL bridges the gaps that exist today”. 

CAREFUL users can send, receive and share responsibility for patient care during peer-to-peer handover, internal referrals, discharges and transfers between organisations. Patient safety is improved because nothing is lost or forgotten. Patient information is added, reviewed and updated at every transition of care to ensure a complete and continuous health story across care settings. Caregivers contribute to the story as the patient moves between community care, hospital, teams and home or back into community care. Patients are invited to access and contribute to their own record.  

CAREFUL uses privacy-by-design principles and is regulatorily-compliant in UK, Europe, USA . As a cloud-based application, it is fully encrypted and protected. It is also fully interoperable using industry standard messaging – so that it can integrate with healthcare systems globally. 

Dr Jeffrey Staples has led large hospital and health systems across Middle East and Asia building quality and operational excellencecommented: “CAREFUL has global relevance across the private and public healthcare sectors. Hospitals find it hard to understand what is happening with patient flow in real time. Important data often stays in clinicians’ pockets or just gets thrown away. In my view, CAREFUL will significantly improve clinical and operational performance.”

Recently, CAREFUL published the results of a study* on clinicians’ experience of handover. The findings were sobering. Errors in handover occur weekly or daily according to 12% of respondents. Nearly 10% had witnessed severe harm because of handover error.  Dr Hamblin-Brown and Ms Hamlani are clear that “We work in an industry that is failing to take seriously the dangers of handover. It is arguably the most common, and one of the most important, processes. We harm both staff and patients if we fail to address the dangers of handover.”

  *Based on 432 completed responses from clinicians in 26 countries via an open, anonymous and confidential online questionnaire completed in February 2022. The full research paper is here: Safety of Handover: A Global Online Survey of Clinical Practitioners and Leaders Regarding Patient Safety during Transitions of Care and summary findings from CAREFUL  can be found here: Handover is dangerous — 10 things we learned about patient safety