Handover
Davy Green
Chinese Whispers
Davy Green
What’s the point?
• Provide seamless care
– Ensure in-hospital team have all the facts
• Transfer important/relevant information
• Building professional relationships
What’s the point?
• Preparation
– Space
– Team
– Equipment
– Advanced help/imaging
What’s the point?
“Handover of care is one of the most perilous
procedures in medicine, and when carried out
improperly can be a major contributory factor
to subsequent error and harm to patients.”
Professor Sir John Lilleyman, Medical Director,
National Patient Safety Agency, UK
What’s the problem?
“Healthcare professionals sometimes try to
give verbal handovers at the same time as the
team taking over the patient’s care are setting
up vital life support and monitoring equipment.
Unless both teams are able to concentrate on
the handover of a sick patient, valuable
information will be lost.”
Junior Doctors Committee, British Medical
Association
What’s the problem?
• Information loss
– Not handed over
– Not understood
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Variance
ED talking not listening
Space issues
Staffing issues
What’s the problem?
• Not just NI ED’s!
– Information Loss In Emergency Medical Services
Handover Of Trauma Patients
Alix J. E. Carter, Prehospital Emergency Care
2009;13:280–285
4.9 Data points handed over per patient
Only 72.9% of these received
What’s the problem?
• Not just NI ED’s!
˗ Maintaining Eye Contact: How To Communicate
At Handover Erin Dean. EN1910Mar2012 06-07
˗ Variance in handovers
93% of time ED asked questions – 1/3 already
had provided the answers
Recommended 20 second hands off time
What’s the problem?
• Not just NI ED’s!
– Review article: Improving the hospital clinical handover
between paramedics and emergency department staff in
the deteriorating patient, Sarah Dawson, Emergency
Medicine Australasia (2013) 25, 393–405
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Paramedics - Confident and succinct
ED staff - actively listening
Structure was needed
Repeated handovers leads to information being lost
?displaying the prehospital observations on a computer screen
NICE Trauma Guidelines 2015
• Record pre-alert information using a structured system and
include all of the following:
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age and sex of the injured person
time of incident
mechanism of injury
injuries suspected
signs, including vital signs and Glasgow Coma Scale
treatment so far
estimated time of arrival at emergency department
requirements (such as bloods, specialist services, on-call staff,
trauma team or tiered response by trained staff)
– the ambulance call sign, name of the person taking the call and
time of call.
NICE Trauma Guidelines 2015
• A senior nurse or trauma team leader should
receive the pre-alert information and determine
the level of trauma team response.
• The trauma team leader should be easily
identifiable to receive the handover and the
trauma team ready to receive the information.
• The pre-hospital documentation, including the
recorded pre-alert information, should be quickly
available to the trauma team and placed in the
patient’s hospital notes.
NIAS PRF Guidance
2.10 - At handover, the clinician must provide a
structured verbal handover with the
accompanying PRF. A format such as ATMIST
will facilitate this but staff should also include
any other pertinent information e.g. patient
medications, use of anti- coagulants, allergies,
known conditions etc.
What’s the solution?
• Standardise
• Proformas
• Multi-disciplinary buy-in
• Team working
What’s the solution?
• Active listening
• Eye contact
• Team leader receiving handover
• Move patient – 30 second ‘hands-off’
• Don’t interrupt!
The Plan
• Use ATMIST
Take 30 seconds hands off for proper
handover
– CPR
– Haemorrhage control
– Compromised airway
– Massive transfusion required
The Plan