Introduction

Handover is the physical and professional transition of care from one provider to the next. The handover of the pre-hospital critical care patient carries significant potential risk. Misunderstanding or misinterpretation of information can have significant adverse impact on patient outcome. Although empirical evidence is scarce in this area, in-hospital reported medical error associated with handover has been reported to be almost 34%,⁹ and in England, during 2010-12, handover was explicitly established as the main contributor in 5% of patient safety related deaths.¹⁰ The pre-hospital hospital transition carries additional potential hazards due to the time critical nature and the multiple human factors involved.

This module will aim to:

• Clarify what information a pre-hospital practitioner can provide.
• Explain how information is shared from the pre-hospital team including the pre-alert and face-to-face handover.
• Introduce ATMIST AMPLE handover tools.
• Team resource management techniques to enhance handover
• Advocate for a hands-off handover when safe to do so and a zero-point survey.

The WHO (2007)⁹ suggested an effective handover is a structured, standardised, focused brief that avoids repetition or interruption and allows time for questions or read-back. Solet et al, 2007 advocated that handovers should be precise, unambiguous and face-to-face.

There are numerous examples of handover tools with the most common in the United Kingdom including AT-MIST and AMPLE which provide a structure to handover. However, to have an effective handover there are additional team resource management skills that need to be utilised to create a shared mental model.

Learning bite

• A handover should be structured, standardised and focused to avoid repetition and allow for questions.
• Handover tools should be used to provide a common structure and a shared mental model.