Abstract
Handover can present opportunities for a number of medical errors. Geriatric patients are at particularly high risk of misadventure as a result of growing medical complexity with age, with such complexity typically resulting in the involvement of multiple clinicians and thus multiple layers of handover during an episode of care. In any given 24-h period in an acute care setting (which includes the on-call shift), a patient may experience up to three regular shifts of clinicians, in addition to being transported between various areas for diagnostic testing, treatment, and observation. The handover at each stage requires a degree of clinical diligence to ensure optimal transfer of care. This chapter will examine handover across various interfaces and discuss ways of optimizing the process. The chapter will also examine handover from the acute care institution to the patient’s residence and primary care physician, as discharge has not been traditionally considered a handover interface, yet it presents a critical transition of care.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Devlin MK, Kozij NK, Kiss A, Richardson L, Wong BM. Morning handover of on-call issues: opportunities for improvement. JAMA Intern Med. 2014;174(9):1479–85.
Manser T, Foster S. Effective handover communication: an overview of research and improvement efforts. Best Pract Res Clin Anaesthesiol. 2011;25(2):181–91.
Joint Commission Center for transforming healthcare: improving transitions of care: hand-off communications. 2014. http://www.centerfortransforminghealthcare.org/assets/4/6/handoff_comm_storyboard.pdf. Accessed 3 Sep 2015.
Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform. 2007;76:801–11.
World Health Organization Collaborating Centre for patient safety solutions: communication during patient hand-overs. 2007. http://www.ccforpatientsafety.org/common/pdfs/fpdf/presskit/PS-Solution3.pdf. Accessed 20 Jul 2015.
Payne CE, Stein JM, Leong T, Dressler DD. Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods. BMJ Qual Saf. 2012;11:925–32.
Farhan M, Brown R, Woloshynowych M, Vincent C. The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department. Emerg Med J. 2012;29(12):941–6. doi:10.1136/emermed-2011-200199.
Agency for health care research and quality: patient safety primers: handoffs and signouts. 2014. http://www.psnet.ahrq.gov/primer.aspx?primerID=9. Accessed 4 Aug 2015.
Borowitz SM, Waggoner-Fountain LA, Bass EJ, DeVoge JM. Resident sign-out: a precarious exchange of critical information in a fast-paced world. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in patient safety: new directions and alternative approaches (vol. 2: culture and redesign). Rockville: Agency for Healthcare Research and Quality; 2008. p. 1–21.
Joint Commission Center for transforming healthcare: hot topics in healthcare- transitions of care: The need for a more effective approach to continuing patient care. 2012. http://www.centerfortransforminghealthcare.org/assets/4/6/handoff_comm_storyboard.pdf. Accessed 3 Sep 2015.
NSW health: implementation toolkit – standard key principles for clinical handover. 2009. www.archi.net.au/e-library/clinical/nsw-handover. Accessed 25 Sep 2015.
Porteous JM, Stewart-Wynne EG, Connolly M, Crommelin PF. iSoBAR – a concept and handover checklist: the national clinical handover initiative. Med J Aust. 2009;190 Suppl 11:152–6.
Welch S. The geriatric emergency department. In: quality improvement and patient safety. American College of Emergency Physicians. 2015. http://www.acep.org/content.aspx?id=87577. Accessed 16 Jul 2015.
American College of Emergency Physicians: Geriatric Emergency Department Guidelines. 2014. http://www.acep.org/geriEDguidelines/ Accessed 28 Aug 2015.
Australian Commission on Safety and Quality in Health Care. Clinical handover: critical communications. Med J Aust. 2009;190 Suppl 11:108–9.
Center for Healthcare Quality and Payment Reform. Using medical homes to reduce hospital readmissions. 2013. http://www.chqpr.org/readmissions.html. Accessed 25 Sep 2015.
Wilber ST, Gerson LW, Terrell KM, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006;13:1345–51.
Snow V, Beck D, Budnitz T, et al. Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine. J Hosp Med. 2009;4(6):364–70. doi:10.1002/jhm.510.
Mixon AS, Neal E, Bell S, Powers JS, Kripalani S. Care transitions: a leverage point for safe and effective medication use in older adults- a mini-review. Gerontology. 2015;61(1):32–40. doi:10.1159/000363765. Epub 2014 Sep 30.
Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications. JAMA. 2007;297(8):831–41.
Tsilimingras D, Bates DW. Addressing post-discharge adverse events: a neglected area. Jt Comm J Qual Patient Saf. 2008;34(2):85–97.
Lenert LA, Sakaguchi FH, Weir CR. Rethinking the discharge summary: a focus on handoff communication. Acad Med. 2014;89(3):393–8.
British Medical Association: Safe handover: safe patients. Guidance for clinical handover for clinicians and managers. 2014. http://bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/contracts/safe%20handover%20safe%20patients.pdf. Accessed 25 Sep 2015.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Abdurrahman, M., Garcia, C. (2016). Safe Clinical Handover. In: Hategan, A., Bourgeois, J., Hirsch, C. (eds) On-Call Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-30346-8_9
Download citation
DOI: https://doi.org/10.1007/978-3-319-30346-8_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-30344-4
Online ISBN: 978-3-319-30346-8
eBook Packages: MedicineMedicine (R0)