Title | Patient handover |
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Justification | As the healthcare system has increased in complexity, we have seen a commensurate increase in the number of handovers both within settings (eg, shift A to shift B, team A to team B, hospital ER-to-floor, floor-to-ICU,) and between settings (eg, home-to-hospital and hospital-to-rehabilitation facility-to-outpatient clinic). At the same time, continuity of healthcare providers has decreased, resulting in transitions of care being more vulnerable to error. This EPA is critical to our ability to sustain and improve patient safety. Handing over the responsibility for a patient and the related patient information requires a core capacity that every physician should have. |
Description | The EPA Patient Handover includes (a) the provision of information about patients to another healthcare provider and (b) the reception of information about patients from another healthcare provider, always in conjunction with the transfer of direct responsibility for this patient's care, in full or in part. The EPA includes all handovers within institutions or settings (such as Emergency room-to-floor, floor-to-Intensive care unit, Operation room-to-floor, shift A to shift B, team A to team B) and across institutions or settings (such as hospital-to-home, hospital-to-rehabilitation setting). It does not include information provision between healthcare providers if the primary responsibility is not handed over. The EPA Patient Handover also includes both oral information transfer and written information transfer (such as through the electronic medical record). The information that is transferred includes at least patient demographics, a concise medical history, current problems and issues, pending lab/radiographic and other diagnostic results information, anticipatory guidance/upcoming possibilities, and a justified to-do list.14 The EPA applies to all clinical disciplines and settings, but can be restricted in content for any discipline. Entrustment decisions to practice unsupervised must include such restrictions. |
Link with a competency framework | Most relevant domains of competence from the competency-framework of the Accreditation Council for Graduate Medical Education: Patient Care, Interpersonal and Communication Skills, Practice-based Learning and Improvement,15 or from the CanMEDS framework: Communicator, collaborator, Health Advocate, Medical Expert.16 |
Required knowledge, skills and attitudes | Knowledge The trainee must have satisfactory medical knowledge to fully understand all details of the condition of the patient, including diseases present and their potential future complications, anticipate future developments, and prioritise competing tasks. Knowledge of all common illness scripts of the discipline and setting is required, if the trainee is to be entrusted with the responsibility to conduct handovers in this discipline and setting. Skills Communication skills pertain to communication with clinicians, with family or with other caregivers. These skills must include communicating situation awareness, illness severity, action and contingency plans to other healthcare providers, preferably using a standardised verbal and written template to improve reliability of the information transfer and prevent errors of omission. The trainee as a healthcare professional accepting responsibility for the patient also has specific communication skills, including clarifying and synthesising information, making sure that the received mental model matches the sender's mental model, and providing feedback to the individual instigating the handover on any errors that occurred, including inaccurate information transmission. Attitude To allow for an entrustment decision for unsupervised practice, the trainee must show willingness to take sufficient time for information transfer, to understand the perspective of the counterpart, especially if not from the same profession, and to serve the patients’ interest above institutional and specialty interests. Teaching approaches Trainees must learn to systematically structure oral handovers, for example, using a mnemonic such as Situation, Background, Assessment Recommendation17 or the newer IPASS (Illness severity, Patient summary, Action list, Situation awareness and Contingency planning, Synthesis by the receiver18) and the electronic medical record as a dynamic tool. A number of focused interactive workshop sessions practicing handovers are recommended. |
Sources of information to evaluate progress | Structured observations during handovers, using an observation and feedback tool, preferably validated19 Structured assessment of written or electronic transfer information Anticipatory guidance—‘what if’ discussion with the trainee to explore ability to cope with challenging case situations |
Estimated stage of training when level 4 (unsupervised practice) is to be reached | End of first year of residency training (supervision at a distance is to be present throughout residency) |
Basis for formal entrustment decisions | At least two supervisors/attendings physicians must have observed at least 10 consecutive oral handovers with a variety of patients and situations, with the trainee in the provider role, and 10 with the trainee in the recipient role, all conducted proficiently and without errors or omissions. At least two supervisors/attending physicians must have evaluated handover information of 10 consecutive patients, with a variety of patients and situations, all judged as being proficient. |