Good handovers are essential to provide good continuous care, maintain patient safety and avoid errors. After every handover, all members of the team should have the same understanding of what has been done and the priorities going forward.
However, the lack of consistent processes, the absence of best practice guidelines and the limited use of protocols mean that handovers are fraught with risk. Poor handovers create discontinuities in care that can lead to adverse events (and subsequent litigation), such as inaccurate clinical assessment and diagnosis, delays in diagnosis, medication errors, inconsistent or incorrect interpretation of results, etc.
The GMC says that you must be satisfied that suitable arrangements have been made for your patients’ medical care when you are off duty. These arrangements should include effective handover procedures, involving clear communication with your colleagues.
The effectiveness of handovers will depend on the accuracy and completeness of the information, and whether it is received clearly and understood by the recipient.
Dr Maisse Farhan is an emergency medicine consultant. She has completed research into how end-of-shift handovers can affect patient safety. She says: “A good end-of-shift handover should encompass clinical and organisational issues, communicating any problems encountered during the previous shift. This would enable the oncoming doctors to anticipate problems.
“A really bad handover is one that does not happen; I have experienced this at various stages in my career – you arrive for a new shift and the night doctor has gone home. Another example of a poor handover is one where a list of patients is handed over, consisting of names and a diagnosis. This would contain no indication of clinical prioritisation or acuity of the patients.”
QUICK GUIDE TO HANDOVERS
The Royal College of Surgeons of England has produced a quick guide to handovers.
The ‘At a Glance’ section includes:
- Begin with a short briefing – “situational awareness”
- Facilitate a structured team discussion
- Establish and develop contingency plans – “what to do if…”
- Encourage questions from the team – there are no “stupid questions”
- As a minimum, ensure the following is imparted:
- Patient name and age
- Date of admission
- Location (ward and bed)
- Responsible consultant
- Current diagnosis
- Results of significant or pending investigations
- Patient condition
- Urgency/frequency of review required
- Management plan, including “what if…”
- Resuscitation plan (if appropriate)
- Senior contact detail/availability
- Operational issues, eg availability of intensive care unit beds, patients likely to be transferred
- Outstanding tasks.