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Handover

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Handover occurs between shifts to ensure everyone is up to speed with patients. The exact nature of how it occurs varies greatly by hospital & specialty. E.g. in paediatrics or critical care all patients are handed over including outliers & outstanding patients requiring review. In medicine, usually only those with urgent outstanding tasks or those that are sick get handed over. In some places, the overnight patients that are admitted are seen with the night team on a “post take” ward round with a consultant.

This variation may dictate how you handover. Some argue starting with the sickest patient (often what occurs on intensive care), in other specialties it may be in numerical order and so you need to emphasise who is the sickest.

Essentially, you want to share key information to colleagues so keep it brief or minds will drift and people will stop listening
  • If you use a list, keep it up to date with relevant information only
  • Key information – name, hospital number, location, diagnosis, plan
  • Use SBAR when handing over (and when requesting a handover)
    • Situation: who you are, where you are calling from, reason for calling (referral/advice), who the patient is and where they are
    • Background: why they were admitted/need admitting, significant past medical history
    • Assessment: significant findings on examination, recent set of observations, key results (bloods/x-rays), give confirmed or suspected diagnosis if have one – say if you don’t know what is wrong
    • Recommendation: could be I need you to come review now, would you like me to do xyz
  • Write down the information you want to ensure is communicated if need be
  • Listen to others handing over and take note of good and bad points
  • It may be useful to flip it around. Think of the information you would like to receive in a handover
For example if you were handing over a patient to your registrar:
Bob is a 70 year old who presented with cough and breathlessness. He is an ex-smoker and bricklayer. He has crackles at left base with consolidation on CxR. He is on IV benzylpenicillin and oral clarithromycin with a CRP of 350. He should continue IV antibiotics until fever settles and have a follow up chest x ray in 6 weeks.

Note only the inclusion of relevant social history & investigations and only relevant details to guide the person to your plan. You could flip this around and say "Bob is a 70 year old retired bricklayer and ex-smoker who presented with cough and breathlessness…etc"

For a written handover, similarly include only relevant details. The focus here is on helping the person quickly ascertain the urgency of the clinical situation should they have a busy shift & spelling out what they need to do.

Patient: Joanna Smith, 01/01/1980, Hosp No: 123456
Information: Pneumonia with AKI. IV abx and fluids. CRP/U+Es better but still spiking temps
Plan: Repeat chest x ray looking for ?empyema. If found, d/w Microbiology & Respiratory for changing antibiotics and for aspiration to confirm empyema.

Note how the plan states the following
  • Why they are doing it
  • What they will do with the result & what they should expect
Remember, the person doesn't know the patient as well as you and the on call team may have far less specialised knowledge than you. 

By Dr Helen Moore ST7 Paediatrics

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