Handover
last authored: July 2012, David LaPierre
last reviewed:
Introduction
Handover describes the process of shifting responsibility for direct patient care from one provider to another. Usually this occurs during in-patient care, from one nurse to another, or from one doctor to another.
Handover is a very high risk activity for many reasons, one of the most important being the lack of sufficient training that many health care providers receive.
Other barriers to effective communication include:
- setting: location, noise, interruptions
- time constraints
- communication barriers: hierarchy, language, communication style
- missing information
- lack of standard communication tool (as described below)
Strategies
Ways of improving the handover process include:
- provide a face-to-face verbal update, instead of using the phone or written methods
- limit interruptions and noise
- prioritize time on those most sick/most important issues
- address upcoming issues
- establish a to-do list
- develop an 'if-then' contingency plan
- allow interactive questioning
- ask for a read-back of key details
- using a standardize tool, as described below
It is important to use a standardized approach to ensure important information is passed on. We recommend trialing them all and choosing one to adopt and hone. Of course it is helpful to have the approach you like best memorized, though feel free to access this page as you see fit as a refresher!
- SBAR
- SIGNOUT
- ANTICipate
- DRAW
SBAR (normally pronounced 'es-bar') is a communication tool primarily used to guide nursing communication with physicians, though it may also be used for physician-to-physican communication or reports between any number of health care providers.
Situation
Identify yourself.
Provide the patients name, age, and gender.
Briefly describe the history, vital signs, and appropriate focused physical exam. Including pertinent positives and negatives, where you deem it to be important. As warranted, results of recent investigations (lab work or imaging) may be provided.
Background
Again, speaking briefly, describe how long the patient has been admitted, and what the admitting diagnosis is (as appropriate). Mention any medical conditions or medications you think may be important. Also, provide information about how the patient's course has been in recent hours or days.
Assessment
Provide a summary of the situation, focusing particularly on why you are concerned. As you see fit, you may decide to mention diagnoses you think could be occurring.
Recommendation
Provide a clear request to the listener. Often you will be wanting them to come assess the patient themselves, and it is important to ask this. Alternatively, you may mention that you wanted the listener to be aware, and that you recommend ongoing monitoring. You may also suggest initial investigations or treatments you believe could benefit the patient.
Once receiving their response, repeat back their instructions to them, so that you demonstrate (to them and to you) that your understanding is clear.
SIGNOUT
- sick or DNR
- ID data
- general hospital course
- new events
- overall health status
- upcoming possibilities
- tasks
DRAW
dx, recent changes, anticipated changes, what to watch for
Resources and References
 |