Clinical Handover & Communication
Clinical handover of a patient represents a vulnerable time during patient care. The WHO's Joint Commission report of 2014 on Sentinel Event Data identified ineffective communication during handover as one of the most common root causes for sentinel events. Sentinel events are defined as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness. In addition, the WHO World Alliance for Patient Safety has identified improvements in communication during patient handovers as a key factor in improving patient safety.
The WHO has presented two guiding principles to minimize communication errors and/or omissions during clinical handover. First, the handover should be tailored to the discipline that it is being used in with context given to end users of the information. Second, the contents of the handover should be standardized in the order that they are presented. By standardizing the contents of a clinical handover it will create a shared mental model between the sender and receiver and convey all necessary clinical information.
- Key principles for effective clinical handover include:
- Appropriate environment for handover should protect patient confidentiality and limit non-critical interruptions during handover.
- Clinical handover information should be timely, accurate and devoid of repetition. Use of common language and minimal use of abbreviations recommended.
- Handovers should be structured consistently to guide the content and flow of information in a manner that suits the clinical context and contain a minimum standard of information.
- The purpose of a standardized clinical handover process is to ensure the safe, effective and structured exchange of information during handover of ambulance patients in the emergency department or receiving facility. Studies have noted that verbal clinical handovers are prone to inaccuracies and omissions; whereas documentation of verbal reports are also subject to frequent error.
- ATMIST AMBO is a standardized handover model that adheres to WHO guiding principles as mentioned above.Research suggests that implementing standardized clinical handovers reduces adverse events and communication related errors in patient care. The use of acronyms and mnemonics is useful to help structure the contents of a clinical handover as they facilitate rapid information recall.
- Clinical handover of a critical patient should include a 20-30 second period where the patient remains on the ambulance stretcher with a “hands-off, eyes on” period until the ATMIST information is delivered (excluding critical interventions).
- SBAR: Provides an easy to use structured form of communication that enables information to be transferred accurately between individuals. Effective tool for use during telephone consultation with EPOS/CliniCall. SBAR helps to reduce communication barriers between different levels of staff and provides clarity of expectations for both the sender and receiver of information.
Interventions: EMR & Above
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