Handing over patients/ tasks is an important part of practicing medicine. Since it is impossible for us to always be the person continuing patient care, it is important for us as medical practitioners to hand over patients to the team coming on in a clear, concise and practical manner.
Below I just have a simple structure along with tips on how to properly have handovers.
General Handing Over Tips
Hand overs should be done verbally, preferably in person. Instant messaging should only be used as a supplement and not as the main or only method.
Prioritise the patients from most critical to least.
Document clearly what needs to be done in the docket so that the team coming on can use the docket as a reference.
Instructions should be clearly written. If a patient is for transfusion the blood product and the volume should be properly documented, the times labs should be repeated should be documented clearly, and so on.
Handing Over A Patient
Start with demographics, focusing mainly on name, sex and age.
Give the location of the patient so they’re easier to find.
Give a concise summary of the patient. This should include why they came in, important examination findings and laboratory findings and say what has been done so far. This should also include what the plan is now.
Give clear instructions on what you want to be done, when you want it to be done and WHY you want it to be done.
Handing Over a Ward
Please note, that this does not cover (explicitly) walk through handovers where you go through the entire ward. .
Start with the most critical patients first.
If a patient has a poor prognosis the incoming team should be made aware.
If a patient is for ‘do not resuscitate’ the incoming team should be made aware.
Be clear about which patients need to be reviewed and why.
Handing Over Between Disciplines
Follow the guide for “handing over patients.”
Give information that is pertinent to the team you’re asking to see/ review the patient. If it is between Obstetrics and Paediatrics, demographic information, gestational age, parity, comorbidities, any pertinent incidents (such as passing meconium stained liquor), current status of mother and baby should be given.
Be prepared to answer questions. This helps the other discipline know the urgency and the tools and help they will need. Eg. calling orthopaedics for a broken limb on a primarily surgery patient. Be ready to give information about mobility, pulse, function etc.
Put it in writing that you have informed the discipline- along with the time and the person you spoke to.
If a patient is for blood transfusion by the oncoming team ensure that the group and cross match is up to date, document and inform the team of the blood group and don’t forget the consent.
When tasks that need to be done are being handed over, actions that could have been taken from before the on call team starts should be done, unless otherwise impossible.
Don’t handover things you had the time to do, but didn’t want/ couldn’t bother to do.
Hand over at your intra-level, intern to intern, resident to resident and so on. You may also hand over inter level as well.
While not usually done, documentation that a task was handed over is good practice.
If it is urgent, make it clear.
Always, get confirmation that your handover was acknowledged and understood.
Not everything needs to be a handover, some tasks can wait until the day team arrives.
Did I miss anything? Let me know. I am eager to hear about your handover experiences.
Samantha C. Johnson