Clinical Handover:

Effective Communication
Prevent Errors
CLINICAL RISK MANAGEMENT WORKSHOP
28 & 29 April 2014

Dr. Sajaratulnisah Othman
Assoc. Professor
MBBS, MMeD (Family Med), PhD

Communication
3
Safety Quality
UMMC

1,100 beds
50,000 admission per year
883,000 patient visits per year
22,000 operations per year
Risk
Hazard
Undesirable outcomes
Heavy workload
Lack of confidence
Inexperience of working
in a particular ward
Reluctance to disturb
more senior clinicians
Distractions
Interruptions
Clinical handover
Safety and quality
Outline
Dimensions of Clinical Handover?
Why we need it?
How to do it properly?
Clinical handover
the transfer of professional responsibility and
accountability for some or all aspects of care for
a patient, or group of patients, to another person
or professional group on a temporary or
permanent basis

[the Australian Commission for Safety and Quality in Health Care and the AMA]
Transfer patient info
Accountability
Responsibility
Ward (am)
Ward (pm)
GP
Dimensions of clinical
handover
What goes wrong in clinical
handover?

In 458 incidents, the most prevalent failure types:
a)Transfer of patients without adequate handover 28.8% (n=132)
b)Omissions of critical information about the patients condition
19.2% (n=88)
c)Omissions of critical information about the patients care plan
during handover process 14.2% (n=65)

[Thomas et al. Failures in transition: Learning from incidents relating to clinical handover in acute care.
J Healthc Qual. 2012 Jan 23. doi:10.1111/j.1945-1474.2011.00189]

Sentinel event
Unexpected occurrence involving death or serious physical
or psychological injury, or the risk thereof.

Most frequently identified root causes of sentinel
events reviewed by theThe Joint Commission by
year
Anatomy of poor handover
Failure to standardize
Lack of updated info
Interruptions
Limited access to computers/phone
Missing participants
Limited face-to-face verbal update (no interactive questioning & read-back)
Lack of task prioritization
Limited verification of understanding


Limited bedside handover
Positive
Frame of reference (eyeballing patient)
Sense of ownership (intro pt to handover doctor)
Negative
Patient anxiety with jargon
Sensitive issues
Time consuming
Limited access to computer
Over-emphasized privacy and concerns
Patterson et al Int J Qual Health Care 2004
Lee et al JGIM 1996
Petersen et al Jt Comm J Qual Improv 1998
Van Eaton et al J Am Coll Surg 2005
ACSQHC July 2005

Quality & Safety of Clinical Handover
depends on
Technical skills-procedural specific skills (Content)
Non-technical skills (How?)
What drives a
good handover?
Handover principles Lessons in action
Leadership
Task allocation
Predicting & Planning
Discipline & composure
Regular briefings
Maintain situation awareness
Use a checklist
Use technology where possible
Regularly review handover processes
Models of Clinical Handover
SBAR (Situation, background, assessment, recommendation)
ISOBAR (Identify situation, background, agreed plan, read back)
HAND-ME-AN-ISOBAR
SHARED (Situation, history, assessment, risk, expectation,
documentation)
SBAR
Situation-Background-Assessment-Recommendation
S: Situation
Identify yourself
Identify the patient (by name and the reason for your report)
Describe your concern
SBAR
Situation-Background-Assessment-Recommendation
B: Background
Give the patients reason for admission
Explain significant medical history

Inform the consultant of the patients background: admitting diagnosis,
date of admission, prior procedures, current medications, allergies,
pertinent lab results and other relevant diagnostic tests.
SBAR
Situation-Background-Assessment-Recommendation
A: Assessment
Vital signs
Contraction pattern
Clinical impressions, concerns
SBAR
Situation-Background-Assessment-Recommendation
R: Recommendation
Explain what you needbe specific about request and time frame
Make suggestions
Clarify expectations
HAND-ME-AN-ISOBAR
H
Hey, its handover time!
A
Allocate staff for continuity of patient care
N
Nominate participants, time and venue
D
Document on written sheets and patient notes
M Make sure all participants have arrived
E Elect a leader
A Alerts, attention and safety
N Notice
I
Identification of patient
S
Situation and status
O
Observations of a patient and call to MET (Medical emergency team)
B
Background and history
A
Action, agreed plan and accountability
R
Responsibility and risk management
Video show
SBAR:
http://www.institute.nhs.uk/safer_care/safer_car
e/sbar_handover_films.html

Trouble with handover short film:
http://www.institute.nhs.uk/safer_care/safer_car
e/Situation_Background_Assessment_Recomm
endation.html
Reflections
How effective clinical handover benefits you
and your patients?

Summary
Proper clinical handover has many benefits
and prevents harm to our patients
SBAR or HAND-ME-AN-ISOBAR are two
models for clinical handover