Patient handover

An ED is responsible for a patient from arrival in the ambulance bay. There is a requirement for Acute Trusts to accept handover of a patient within 15 minutes of an ambulance arriving in ED or other urgent admission facility.

As the team leader the face-to-face patient handover is vital as it may be the only information regarding mechanism, interventions, past medical history and identity of the patient immediately available. Ensuring this process is uninterrupted and given to all members of the team at once is key. To achieve this, a hands-off handover should be the standard, if safe to do so, ensuring 1 minute of silence.

If there is a need for on-going continuous critical care to be provided, such as active CPR or a critical airway intervention, there may be the need to perform these limited clinical interventions before a whole team handover. Any immediate interventions that are required on arrival should be clearly articulated to the team leader and co-ordinated. If not articulated the team leader should clarify if any immediate interventions are required.

A hands-off handover will aim to ensure the whole team is attentive and allows questions to be asked. This ensures that all members of the receiving hospitals team hear the same information, once.  Whilst this may seem to delay care initially, it aims to facilitate initial planning by the trauma team leader and allows rapid horizontal care after handover without delay.

At handover the scribe will need to note down all relevant information. A dedicated scribe for the team needs to be familiar with the paperwork. A scribe does not need to be clinical and overnight in smaller trauma units may be a role for ED admin staff with adequate support. It is worth considering, in your department overnight, who is best to provide this role and ensure appropriate training and support. Carter et al, 2018 showed that only 72.9% of key prehospital data points verbally handed over were documented by the receiving hospital.  To prevent degradation of information the use of a structured handover sheet that mirrors the pre-hospital handover with a dedicated scribe should be encouraged.

_{(Image courtesy of Dr D Maxwell)}

Learning bite

• On arrival of an ambulance the Acute Trust is responsible for the patient.
• Handover should be facilitated as soon as possible
• Handover is the formal full clinical handover of a patient
• To maximise the information shared the whole team should be present and hands off.
• A scribe should capture the handover in the patients notes. Consider within your ED who is best for this role at all points in the day and night and incorporate this into any departmental SIM.