Handovers: art and scienceDr Adam Chesters FRCEM FIMC

Consultant in Emergency Medicine and Pre-Hospital Emergency Medicine

Handovers in a patient’s journey 999-rehab

1. First responders to ambulance service

2. Ambulance service to HEMS

3. HEMS to trauma team

4. Trauma team leader to receiving specialty/ITU/theatre anesthetist

5. Theatre anesthetist/surgeon to ITU

6. ITU to ward

7. Ward to GP

• And all of the other shift/department/ward handovers in between…

What are the risks of handovers?

• Information loss/distortion

• Focus loss

• Dead time

• Responsibility hiatus/overlap

• Confirmation bias

The principle of a handover is to:

• Give the right information

• To the right person

• At the right time

• Consistently, every time

Giving the right information

• Have a standardised system

• Injury vs. illness

• Systems-based

• ATMISTER

• SBAR

• ASHICE

• ABCDE

Handing over at the right time

• Let the receiving team leader control their team

• Keep control of the patient until you are happy that a safe handover of care, information, and responsibility has occurred

• “you have control”

• “your airplane”

• Ensure that the patient is in a ‘safe configuration’ before handover

Handing over to the right person

• Being the patient’s advocate

• Who is the ‘right’ person

• TU national requirements

• MTC national requirements

• Specialist requirements

My practice for trauma handover

• Safe configuration

• 5 second round/immediate needs handover

• Decision whether to transfer patient across to ED trolley immediately

• Clear leadership of the transfer

• Let the TTL control their team, ask them to tell you when they’re ready – this is no-man’s land

• Walk away once you’ve given your handover

Departmental handovers

• Every time departmental leadership changes

• Dedicated time, overlapping shifts

• Free from interruptions

• Same principles as patient handover• Consistent and relevant information

• To the right person

• At the right time

Thank you