Regardless of what specialty you practice, what setting you're in, where in the UK you work, all doctors routinely perform handovers.
A succinct and clearly communicated handover will ensure your patient receives tailored care on time – the same care out of hours as they would have had in hours.
There is no one perfect handover process; it is as bespoke to you, as the plan handed over is to the patient concerned.
Over time, be it from experience, learning from others or trial and error, you will refine and perfect your handover process.
Remember – handover is one of the single most important duties you will routinely perform as a junior doctor, so whatever your process, make sure it enables you to deliver the best care to patients.
Whether you are providing the handover, or taking the handover, it is imperative you are on time.
Unless the patient you are with needs your care as a matter of urgency, whatever you are doing can wait until after the handover.
Your handover will affect the care of many patients and must take priority.
Keep your team informed
If you are held up, let your team know.
Tell them where you are, what you’re doing, how long you’ll be, and whether you need help.
If you can’t leave the patient and you don’t have access to a phone, ask the nurse with you to make the call.
Take an extra pen and paper. If you’re a fan of colours, use a highlighter or coloured pen.
Aim to start handover when both teams - the providing team and the taking team - are present.
This will ensure information isn’t duplicated and the right, complete handover is given first time, to avoid confusion.
Cover all the bases
The providing team is likely to know the patient better than you. You can’t predict the possible scenarios, so while they are there ask what they would like you to do in each situation.
For example, if you’re asked to “Start the patient on IV fluids,” consider asking:
“Have bloods been done?”
“Should I take bloods when cannulating?”
“Do I wait for the blood results?”
“What fluids would you want us to start?”
“What should I do differently if the Urea is high?"
What else might you need to know?
Know your contacts
There is a possibility that something unexpected might happen, something which wasn’t anticipated at the handover. Who do you contact?
Know your escalation numbers:
- the on-call team
- your seniors
- the MDT
- the bed manager.
Does the on-call consultant wish to be contacted, and how?
Know your way around the hospital
While rotating between different hospitals offers invaluable experience, the day you rotate can be really difficult.
Make an effort to familiarise yourself with the hospital:
- the main wards
- the labs
- the canteen
- the handover room
- the mess.
Keep it succinct
Often the paper handover can become crowded and overpopulated with outdated and unnecessary information.
If you get a chance in your busy shift, ensure all the details are up to date and relevant.
Have a system
Many hospitals/trusts attempt to impose a handover system upon you; ISBAR (Identity, Situation, Background, Assessment, Recommendation) is just one example.
However, they may not work for you.
As long as your system covers all the areas and equips your team with the necessary information ensuring patients receive the care they need, it is good enough.
You should aim to prioritise your jobs as you are being provided the handover. That way, you can plan your shift.
If you’re not sure of something, whether it’s where a ward is, the dose of a medication, if you’re doing the right thing, or what the person handing over just said, ask!
There is no such thing as a silly question. No one should make you feel there is. And mistakes are best avoided by ensuring you are supported.
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