Clinical handover

Clinical handover is the ‘procedure’ we use in hospitals for transferring “professional responsibility and accountability, in writing and face to face, 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.”1

It has been recognised as a high risk area for patient safety and a priority for all clinicians.

It can occur:

  • shift-to-shift
  • ward-to-ward
  • between clinical staff
  • between disciplines, and
  • between treating teams.

Good clinical handover includes considering if:

  • environmental factors are impacting or might impact the patient1
  • a patient needs significant care or immediate attention1
  • a patient is deteriorating or might deteriorate (see Standard 9)1
  • occupational health and safety issues need to be addressed1

The process is enhanced when:

  • it follows a standard format
  • uses a checklist
  • contains a minimum dataset1

As clinicians it is our responsibility to understand and follow the documented and standardised clinical handover processes in use at our health services.

Many Victorian health services are moving towards involving patients and their family in bedside handover wherever possible and appropriate, such as during shift-to-shift and ward-to-ward handovers within daylight hours. This provides the opportunity to invite patients and their family to take small evidence based actions to keep well during their stay in hospital.

Handing over involves communicating the actions needed to address the person’s presenting problem and the actions needed to prevent additional problems occurring. This includes incorporating strategies outlined in the topics to prevent functional decline.

ISBAR/ISOBAR

Victorian health services are using the ISBAR or ISOBAR1 tools as a means to implement standardised clinical handovers. Each of the components of these tools contains essential elements to guide clinicians in the process of face-to-face and written handover2,3

I – Identification of patient

  • Should include three patient identifiers such as name, date of birth and medical record number
  • Current clinical status
  • Advance care planning
  • Person centred care requirements
  • Prospect of discharge or transfer

S - Situation and status, including risk of delirium, pressure injuries, falls, continence and medication issues and so on

O – Observation, including latest risk assessments, examinations etc

  • Latest observations and when they were taken (NSQHS Standard 9 recognising patient deterioration)
  • Presenting problem
  • Background problems
  • Current issues
  • Evaluation (examination findings, investigation findings, current diagnosis)
  • Management to-date and an assessment as to whether the management is working

B – Background and history

A – Assessment and actions, including risk assessments and successful management strategies such as providing water with meals to alleviate swallowing difficulties

  • Understanding of what problems are being treated or clear communication that the diagnosis in unknown
  • Tasks to be completed
  • Abnormal or pending results (includes recommendations and an agreed plan and who to call if there is a problem)
  • A plan for communication to the senior in charge
  • Clear accountability for actions

R – Responsibility and risk management, including documenting and recording all successful/unsuccessful prevention strategies

  • Responsibility and task acceptance from the incoming team ideally includes signing or accepting handover sheets
  • Read back of critical information by the incoming team
  • Where risks are identified for a patient ensure clinical risk management plans are included in handover.

1. 'Safety and Quality Improvement Guide Standard 6: Clinical Handover (October 2012)', (Sydney: ACSQHC, 2012).

2. Clinical Communique [electronic resource]: Department of Forensic Medicine Monash University Victorian Institute of Forensic Medicine, 2 (2015).

3. Australian Commission on Safety and Quality in Health Care, 'The Ossie Guide to Clinical Handover Improvement', (Sydney: ACSQHC, 2010).