Handover Guidelines for Residency Programs

The handover of patient care is a critical skill required of any physician and must be taught in each residency program. It is clear that the clinical handover may vary between clinical experiences and between geographic settings. Each residency program must have a written handover policy which is applicable to its particular set of circumstances. The guidelines below may be adopted as the policy, or they may be used as “guiding principles” for a more specific program-based policy.

1. Location / Setting

The location or setting of the handover for each clinical rotation or experience must be determined by the clinical supervisor and be clearly communicated to the resident. The setting may be in a closed room adjacent to a clinical area, an outpatient or office setting, on the telephone or other settings where patient confidentiality and concentration can be ensured.

2. Timing

Handover occurs when there is a change in the most responsible physician and/or when there is a change of resident responsible for patient care. Examples include but are not limited to: rotation or shift changes, completion of in-hospital on-call shifts, or outpatient follow-up required for continued patient care.

3. Absence of distractions

The handover of patient care must be seen a priority by residents and clinical supervisors. When possible, pager and phone interruption should be minimized to ensure proper transfer of information.

4. Participants

The participants at the handover will be determined based on the clinical setting in which the handover occurs. On teaching units, this would include the designated outgoing resident, all incoming residents and medical students, the nursing clinical leader/charge nurse or designate and attending clinical staff as required. In other settings, the participants may include the designated resident and the attending physician and/or incoming resident.

5. Format

The format of handover will be determined based on the clinical setting. On a teaching unit there should optimally be a face to face review. The priority of patient presentation is based on clinical acuity and need for clinical intervention. Within the handover there will be a defined role for each participant with assignment of TO DO responsibilities and reporting of results: In general the procedure in this setting follows the following process: -Consensus of IF -> THEN plan -Closure of loop by reporting - student -> resident ->attending staff -Confirmation via read-back.

In the outpatient setting or non-teaching unit inpatient setting, the handover may be on the telephone or in a location away from the clinical environment as agreed upon by all parties. The format of the handover may depend on the acuity of the patients involved or the follow-up required.

6. Documentation

Documentation required for handover must contain accurate patient information. This must include a list of patients being discussed. Inpatient charts should include content details as described below: Outpatient documentation may include verbal or written communication between the resident and attending physician or another resident. The content should also follow the outline below.

Ability to update document at any time by house staff at all levels

Content (ISBAR)

I : Identifying data
Patient name and/or medicare or hospital ID number Room #, or telephone number
Admitting diagnosis or presenting complaint
Code and intubation status if appropriate

S : Situation
Clinical status – stable or clinical change

B : Background
Clinical course since admission or since last outpatient assessment Co-morbidities

A : Assessment
Current clinical assessment Stable or working diagnoses

R : Response
Recent / current investigations and management
Results of recent / current investigations and management
Plan / recommendations for upcoming investigation and management