Passing the baton: The importance of good handovers
Good handovers provide continuity of care and can help to avoid errors. It is common for problems to arise when a doctor is handing a patient over to another doctor for treatment – either between shifts, between phases of care, or between community and hospital care. These problems can put the patient’s safety at risk and it is therefore vital to ensure effective handovers. These will depend on the timeliness, accuracy and completeness of the information given, and whether it is understood by all parties.
Inconsistent processes, the absence of best practice guidelines and limited use of protocols mean that handovers can be fraught with risk. Poor handovers can result in adverse events, avoidable harm and complaints involving:
· Inaccurate clinical assessment and diagnosis;
· Delays in diagnosis and treatment;
· Delays in ordering investigations;
· Medication errors;
· Inconsistent or incorrect translation of results;
· Duplication of investigations;
· Increased length of stay;
· Increased in-hospital complications; and
· Low patient satisfaction.
A poor handover can have a significant impact on the quality of care of a patient, resulting in complaints. The lack of clear leadership or responsibility when complications arise, failure to effectively communicate the patient’s condition, inappropriate delegation to a doctor without sufficient expertise, and the lack of an agreed care plan are some of the risk areas to look out for.
In reality, most handovers are done with the best intentions, but informally. Doctors can be distracted and trying to do several things at once, which can affect levels of concentration.
A good handover should be a two-way process. It is an exchange of information and an opportunity to ask questions and confirm that the exchange has been successful. It should be structured and focused on making suitable arrangements for the patient’s medical care, with minimal interruptions. Checklists can often be used in order to help with the management of common conditions.
A good handover should include:
· A senior clinician to lead the handover;
· A shared understanding of the plan of action, who is responsible for each aspect of the patient’s care, and exactly what is required;
· Designated handover time within working hours (at least 30 minutes for large hospitals);
· Involvement of all relevant health professionals, as more information is needed for high-risk patients;
· A clear method of contacting the doctor responsible for a particular patient;
· Awareness of potential risks;
· Information for the patient as to who will be responsible for his/her care going forward; and