Handovers





Handing patients over

A. Identification data:

  • Name, age, gender, UR no, ward/bed number
  • Admission date
  • Primary consultant

B. Important information to handover:

  • Clinical background
  • Tasks / plan
  • Context

1. Clinical background

  • List of patients ranked according to urgency

  • Current major issues

  • Brief history of presenting complaint (HxPC)

  • Active problems by system (PMHx)

  • Recent procedures or significant events

  • Baseline status

    • Vital signs
    • Key investigations

2. Tasks / Plan

(i.e. what needs to be done or may need to be done)

  • Specific actions

    • If.... then...
    • Criteria for repeating reviews

  • Warning of pending information

    • e.g. Ix results, review by another team, etc

  • Contingency planning

  • Rx so far

    • What Rx has been instituted
    • What Rx has or has not worked before

3. Context

  • Code status

    • Do not resuscitate status (DNR)
    • Recent changes or family discussions

  • Difficult family or psychosocial issues

  • Safety concerns



Mnemonics

AMIST

Useful for handover of a trauma patient

A - Age and demographic

M - Mechanism of injury (how did the injury occur?)

I - Injuries (what are the injuries?)

S - S&S (vitals and abnormal S&S)

T - Treatment

End with

  • ETA (if applicable)
  • Any further question?

ISOBAR

Used by QCC for keeping track of patients

  • I = Identification / Immediate needs
    • Identification of persons
      • Myself and team
      • Patient
      • Receiving doctors
    • Immediate needs (or lack thereof)
  • S = Situation
    • What happened, what is wrong
    • What is my concern
      • i.e. Why am I talking to you?
    • Mechanism of injury
  • O = Observations
    • Vitals
    • Patient is stable / not stable
  • B = Background history
    • Reason for admission (and date)
      • i.e. Why is the patient here?
    • Recent procedures if any
    • PMHx
      • Previous function
    • Ix
    • Medications and allergies
    • Resus status
  • A = Assessment
    • Diagnosis / Clinical impressions
    • Current major/active issues or concerns
  • R
    • Response to treatment
    • Recommendation
    • Requirements
      • What do I want? What would I like to happen?

⦿ NB:

  • Addenbrooke's uses the SBAR handover system
    • Situation (Also includes "Identification" and "Observation")
    • Background
    • Assessment
    • Recommendation (Also includes "Requirements")

SAMPLE

Useful for preop patients or quick handovers

  • S = S&S
  • A = Allergies
  • M = Medications
  • P = Past history
  • L = Last oral intake
  • E = Events leading to incident