- Can be verbal or in written form
- Identified as an event that regularly presents high risk-exposure to patient care
- Incomplete or misinterpreted information leads to delays in patient review, an under-appreciation of illness, or delays in adequate response to deterioration
- It occurs whenever there is a transfer of responsibility (temporarily or permanently) of components of patient care to another clinician e.g. doctor-nurse, doctor-doctor, specialist-GP, doctor-allied health etc
- The principles of handover can be applied similarly to patient referrals, clinic letters and discharge letters
- Performing good handover should never be routine, it requires careful thought and preparation
- Despite the various tools and mnemonics that are available to improve consistency and completeness in the process e.g. SBAR, ISBAR, ISOBAR, I-PASS, I-PASS, ABCD, it is always worthwhile first reflecting on all the patient information at hand and synthesising the essential facts that need to be conveyed
- Over-inclusivity can be as dangerous as scant information by drowning out the important messages with irrelevant information. Tools can be used poorly.
- Beyond the components of the patients history, examination findings and provisional diagnoses, it is essential that clinicians must convey an impression of how stable or severe their condition is, the timeliness for next review and contingency plans if the situation deteriorates..
- The latter aspects are actually more important to risk evaluation than diagnoses and is reflected by the chronological progression of disease.
A way of summarising this is in the following graphic
- Structured format are useful in organising your thoughts and can be applied verbally or in written form
- Be succinct
- If the situation is dire or critical learn to use scripted approaches, Use phrases like ‘I am worried about…”, “I have a puzzling situation I am concerned about”
- Use natural prose to convey a progressive and logical flow
- Following the handover, it is important that the receiver performs a read-back that confirms they have correctly interpreted the important points (see the above graphic again)
The following format is a good summary and is particularly suitable for the acute care environment (it can be modified accordingly for community and primary healthcare)