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At the appointed time, in a designated room somewhere in the hospital, two sets of weary people convene - the night and the day teams, at opposite ends of their shifts, each tired in their different ways. It’s handover time.
For the night team the first clue to how their shift is going to go is how late the members of the day team arrive. Five or even ten minutes is not out of the ordinary, and might even suggest that their conscientious outgoing colleagues are taking a few more minutes to get another clerk-in struck off the list. If no-one has appeared by the twenty minute mark, however, it’s a very ominous sign.
The second clue is their demeanour as they come in. Relaxed and cheerful, obviously, is good. A grim apologetic smile from the registrar usually means there are at least ten to see on the take. And when the wards SHO arrives slightly out of breath clutching several rumpled and well-scribbled on sheets of paper, you know there are a few ‘sickies’ about.
When enough of the participants are assembled, proceedings begin. Traditionally, the medical registrar is master of ceremonies, as well as chief scribe.
Things progress with variable efficiency. There’s an acquired art to good handover that resists distillation into handy mnemonics like ‘SBAR’. In particular, gauging the appropriate level of clinical detail to go into is something mostly learned through experience. As is judging what actually warrants a mention and what probably doesn’t.
It probably wasn’t necessary, for instance, to hand over the patient on treatment for deep vein thrombosis ‘just in case’ they might develop a pulmonary embolism and become short of breath. But this was at the first handover meeting at August changeover and the F1 had just finished his first ever twelve hours as a doctor, so allowances should be made. (It was, however, a very long meeting.)
You hone your handover techniques largely through trial and error, and you usually get instant feedback in the reaction from your colleagues. It can be a little intimidating at first. At best, though, handover can be a forum for learning - a chance to ask for a second opinion, or participate in what is effectively a series of mini case discussions.
As things draw to a close, there’s often a few minutes of small talk, everyone perhaps slightly reluctant to leave the relative sanctuary of the meeting room.
Lately I’ve noticed the emergence in my hospital of a sort of ‘fringe handover’ after the main event, when the F1s tell each other about those little things that don’t seem quite important enough to tell the whole room about – someone’s warfarin that still needs prescribed, routine bloods needing checked, or some subtlety about dealing with a particular patient’s challenging behaviour.
Then the day and the night teams go their separate ways - the day team, unburdened, heading for home; the night-team newly encumbered with tasks and responsibilities, dispersing towards the waiting wards.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter
How very true
Delighted to hear handover exists. Very little evidence of it happening in my hospital in terms of expected results from all the imaging being requested... And no one wants to hand over the task of actually arranging a scan - so radiologists get a call from the night teams just as they all leave the hospital!
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