Transitions
of Care
Patient Handoffs/Harbor-UCLA
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Page 2: Case Example
Page 3: SBAR
Page 4: I-PASS Patient Summary
Page 5: I-PASS Action Plan
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Tutorial launched
March 2014
Department of Medicine
Darryl Y. Sue, M.D.
Welcome to a Patient Handoff Tutorial
Complete Pages 1-5 from Menu above. First, review the slide show on handoffs...
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1. What are some features of a systematic patient handoff?
A. Decreases loss of patient information
B. Increases the cost of care
C. Required to be taught in all post-graduate training programs.
D. It lets the handoff receiver learn by making independent decisions when events occur.
E. It must be updated to current status of the patient.
Show/Hide the Answer and Discussion for Question 1
A, C, and E are most correct.
Systematic patient handoffs have been demonstrated to decrease loss of key patient information; every time a patient's care is transferred to someone else, some information is lost. A good handoff continues to pass on the important information.
While "more time" and, therefore, some cost is incurred with systematic handoffs, studies have demonstrated the potential to decrease overall cost by reducing patient care errors, as well as having more consistent care over time. There are suggestions that appropriate handoffs decrease procedures, errors in medications, and conflicting plans.
The ACGME and other accrediting organizations have required instruction and monitoring of patient handoffs as part of all residency programs.
One of the goals of successful patient handoffs is to provide as much guidance to the person receiving the handoff when an anticipated event occurs. That is, the receiver should be given a specific action plan rather than having to make up a new and possibly untried action. A systematic patient handoff will have a number of specific "if...then" action plans.
In general, the receiver of a patient handoff should be given the most up-to-date information. For example, if there was a wide differential diagnosis still on Day #1, this should be reflected in the handoff. But, when a specific diagnosis has been made by Day #3, the differential diagnosis should reflect the change.
2. What should you expect to see in a written patient handoff?
A. A complete description of how the patient initially presented.
B. The original differential diagnosis at the time of admission.
C. Concise information without unnecessary data.
D. Complete medical record so receiver doesn't have to look up anything from "chart."
E. Anticipated problems and actions.
F. A systematic and consistent methodology.
Show/Hide the Answer and Discussion for Question 2
C, E, and F are most correct.
The systematic written handoff is NOT a substitute for the entire medical record, and there will occasionally be a need for the handoff receiver to look up additional information. An appropriately updated written handoff no longer needs to include how the patient initially presented (imagine a patient with a 30-day hospital admission with many changes in his condition).
Conciseness is key to patient handoffs because there is usually limited time to convey information and the most important, relevant, and anticipated data are the most important to emphasize.
The most important features are anticipated problems/action plans and a consistent method for presenting the key information and potential issues.
3. When should there be a systematic patient handoff?
A. When a patient is transferred from the ICU to the PCU.
B. When a patient is discharged from the hospital.
C. Only when a new physician or nurse assumes care of the patient.
D. Only when the "on-call" physician begins a shift.
E. Only for inpatients.
Show/Hide the Answer and Discussion for Question 3
A and B are most correct.
We often consider systematic patient handoffs when someone "covers" our patient. While patient handoffs most often take place for inpatients (after all, transitions of care occur multiple times per day when nurses change shifts, the patient is transferred within the hospital, or when an on-call physician assumes care), a handoff occurs at the time of discharge and occurs in clinics as well.
In fact, you should think particularly about how your ambulatory clinic note will be interpreted by yourself when you next read it! Will you remember what you were thinking? Will you know what your anticipated results will be? What if someone else sees the patient instead of you? Will your note lead to the appropriate action by you or your colleague a month or two later? Therefore, you should think about your clinic notes as a systematic "handoff" of care, even if to yourself.
