The art of a "handover"

ExpatMedic0

ExpatMedic0

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So I work with some great people, but I could not help but notice when crossing paths in the ED or arriving as a second unit, that some of their handovers are a bit much.
Some of them rattle on and on, giving me every single vital sign detail( B/P, HR, RR, SPO2,)and a long and often confusing story of what happened . I dont mean to be rude but sometimes I just have to stop them and ask "why was the ambulance called today" if I am a second unit, or if I am passing them by in the ED as they give report to ED staff I just look on and wait for the nurse or doctor to cut them off.
On the other hand I work with another guy who tells you absolutely nothing, maybe the chief complaint if your lucky.

I have my own method of stating the chief complaint/ why the ambulance was called, stating "vital signs within normal limits, (if they are) and only pertinent medical history. In most circumstances I do a handover in 5-10 seconds(unless a lot of ALS procedures have been used and need to be mentioned) and then allow the person receiving to ask any questions if they have any.

Whats your opinion, how long does your handover last for a routine patient and what information do you give
 
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DesertMedic66

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Generally our nurses and doc like a full report of everythin for critical and non-critical patients. Name, age, c/c, secondary complaints, pertinent negatives, OPQRST, medical history, allergies, all vitals, EKG, BGL, our treatments, and our unit number.

They will be writing down all the information they want on a piece of paper. My goal is to have the Doc or RN not have any questions to ask me after the report.

Now when we are getting a hand over from fire or for IFTs, we get some poor reports. Had one patient from an urgent care today where my hand over was literally "hey guys, this is John. He has some right sided facial droop so I called you to take him to the hospital".
 
NYBLS

NYBLS

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"This is so and so, an 87 year old who called 911 one hour ago complaining of this and I found this. Heres how she was presenting, heres what I did, heres the vitals/EKG, heres what I have for access. Any questions?"
 
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Chewy20

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Chief complaint, vitals are within normal limits (if they are), when it started, what we did for them.

They are usually already looking at our tablet for meds, history, allergies and all that mumbo-jumbo.
 
Clare

Clare

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The national standard is physical, in-person handovers is IMIST-AMBO

• Identification.
• Mechanism of injury or medical complaint.
• Injuries identified or information related to the medical complaint.
• Signs and symptoms.
• Treatment and trends.
• Allergies.
• Medicines.
• Background (medical background).
• Other (for example family and social situation)

For RT calls to hospital (R40) the format is

• Vehicle callsign,
• Patient age and sex,
• Diagnosis (or brief description of complaint),
• Significant treatment provided (routine treatment is not described),
• Status (acuity)
• ETA

In Auckland we only have to pass an R40 for patients who need to go resus or cath lab etc, patients who do not require immediate intervention can just be presented to the triage nurse or waiting room as applicable. In some areas, particualrly small hospitals, the hospital wants to know of all incoming pts.
 
Ewok Jerky

Ewok Jerky

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I think this is a skill that takes time to develop. You have to know your audience. Do they really care? Do they have time to care? Is it really important that you tell then RIGHT NOW about Mr Jone's Hx of hemorrhoids? If you are concerned about GI bleed maybe it is, if all he has is a distal radius Fx then probly not. That is the art of knowing your audience. If they aren't listening you are just wasting their time, and yours. Knowing what is pertinent and what isn't is the key to a good report.
 
ERDoc

ERDoc

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Personally, I like it kept short. I'm going to have to ask things again anyway. The most important things to me will be what you did and what effect it had. In certain cases such as MVAs, what you saw is also very helpful.
 
Tigger

Tigger

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Patient's name, age, where he/she is coming from, and why we were called. Followed by what I found and any pertinent history to that. For whatever reason the hospitals want a full set of vital signs as well. We usually give our reports to the doctor, so once that's done I'll usually stand around for a bit to answer any more specific questions for the nurse who is charting. I try to have a sheet with demographics, PMH, allergies, meds, and a set or two of vitals along with whatever access I have documented for them as well.
 
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Aprz

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I like what Ewok Jerky said about knowing your audience. There are hospitals that wanted to hear every last little detail and play 20 questions. There are hospitals that pretty much want me to point at the patient "This is the patient. Where do you want me to put him?"

I personally just identify the patient, say why they are coming in, pertinent negatives/positives, give last set of vitals, and treatment if any. The fire department has a piece of paper that has the history, allergies, and medications that I just hand a carbon copy of that to the staff and point out it has that info.
 
RedAirplane

RedAirplane

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Clare said:
The national standard is physical, in-person handovers is IMIST-AMBO

• Identification.
• Mechanism of injury or medical complaint.
• Injuries identified or information related to the medical complaint.
• Signs and symptoms.
• Treatment and trends.
• Allergies.
• Medicines.
• Background (medical background).
• Other (for example family and social situation)

For RT calls to hospital (R40) the format is

• Vehicle callsign,
• Patient age and sex,
• Diagnosis (or brief description of complaint),
• Significant treatment provided (routine treatment is not described),
• Status (acuity)
• ETA

In Auckland we only have to pass an R40 for patients who need to go resus or cath lab etc, patients who do not require immediate intervention can just be presented to the triage nurse or waiting room as applicable. In some areas, particualrly small hospitals, the hospital wants to know of all incoming pts.
Click to expand...

I'll have to try this. My reports vary in quality and I always feel like I'm forgetting something.
 
CALEMT

CALEMT

The Other Guy/ Paramaybe?
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Am I the only one who has been reading the title of this thread wrong? For half the day I thought the title was The art of a "hangover".

For the OP I just follow along the PCR. Name, age, cc, vitals, med hx, pertinent negatives, assessment findings (OPQRST/ SAMPLE), allergies... you get the gist of it.

Edit: Pretty much what Desert said.
 
Jim37F

Jim37F

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Yeah, I'll tend to just follow the PCR myself, though it all seems to depend on the hospital, and even the individual nurses taking the report how much they want. Anecdotally it seems that a stable BLS patient whose A&O will more often be a shorter handoff, and they'll start asking the patient all the questions while looking at the PCR while we move them. That's not guaranteed of course, but I can easily run the gamut of handover reports from "where do I sign?" to the full detailed report like the above^ (I think I might have to borrow RedAirplane's idea to keep that format in my back pocket for when they want it haha).
 
OP
OP
ExpatMedic0

ExpatMedic0

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Definitely some good replies regarding "knowing your audience," I think this applies not only from region to region, but even hospital to hospital or staff member to staff member. The condition of the patient and anything that's been done is also another factor for sure. I guess for me personally, I only like to give whats absolutely pertinent to that specific patient. For the majority of stable patients with little or no interventions I do this in well under 10 seconds, and I think thats fine. I do not list any of the vital signs individually unless they are outside normal limits or the receiving party ask. I find this goes a lot smoother and then I invite to ask the receiving party if they have any questions. I guess what bothers me is if I am called for something like hemorrhoids for example as someone mentioned, and I get some 1-2 minute long spiel from the on scene crew that includes information that's just not pertinent. Good to hear everyones input and opinions though, and clearly it does vary regionally and from provider to provider some.
 
NomadicMedic

NomadicMedic

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The only patients I ever give an "extended" hand off on are trauma (at the Level I) or a critical/serious medical patient. Usually the trauma team wants a full story and if it's a critical medical patient, the Doc (and the person documenting) needs to know what I did prior to arrival at the ED, for continuity of care.

Otherwise, it's "This is Gladys, she's 68 and has been having trouble breathing since this morning. She has a history of COPD and she's doing a lot better after a duoneb. Here's a list of meds, no allergies and ... what else would you like to know?"

If there's something that they NEED to know, I'll mention it during that transfer. Otherwise, short and sweet.
 
Ewok Jerky

Ewok Jerky

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Also, when I learned how to give a report in PA school, the power of SOAP was revealed to me. It is so adaptable, it can be a 10 second oral presentation or a 3 page written note, or anything in between.

Subjective- anything they tell you, including Hx.
Objective- anything on physical exam or relevant labs.
Assessment- what are you treating, what's on you're differential.
Plan- what are you doing about it, what do you want to do.
 
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