High Quality Handovers
Christine Hamilton
Vanderbilt IM uses the “handoff” tab in eStar. Update all components of the handover daily:
Synopsis
- Include patient’s name, age, pertinent medical history, and key hospital diagnoses/events. For example: “John Doe is a 57-year-old man with a past medical history of HTN and HLD who presented with NSTEMI, now s/p LHC on 3/7, on DAPT.
- Include code status and, if applicable, capacity to leave AMA
To-dos
- Provide specific instructions on the task to be performed and at what time.
- For example: “21:00 – Follow-up intake/output. If urine output is less than 2L, order 160mg IV Lasix.”
- Ensure the covering person has the resources to act. For example, if following-up a CBC for a pt with GI bleed, make sure the pt has a reliable form of access and has consented for blood.
Contingencies
- Should include instructions for common overnight pages as well as patient-specific recommendations. At a minimum, contingencies should address: pain, fever, nausea, hypoxia, hemodynamic instability, tachycardia, and AMS.
- Write contingencies for patient-specific situations and what you would do differently for your patient than other patients on your list.
I-PASS
- When giving verbal handoff for complicated patients, use the I-PASS technique:
- I: Illness severity (stable, watcher, unstable)
- P: Patient summary (one-liner with working/confirmed diagnosis, key elements of hospital course including major medication changes/procedures/interventions, and any pertinent physical exam findings or lab result (important particularly if a patient has known neuro exam findings, baseline severe hyponatremia, etc in the event they are called about this)
- A: Action list: formatted as to-do’s, above
- S: Situation awareness: i.e., contingency planning
- S: Synthesis by receiver: summarize the pertinent diagnoses, action list, and clarify any questions