1. Handover
Davy Green

2. Chinese Whispers
Davy Green

3. What’s the point? Provide seamless care
Ensure in-hospital team have all the facts
Transfer important/relevant information
Building professional relationships

4. What’s the point? Preparation Space Team Equipment
Advanced help/imaging

5. What’s the point?
“Handover of care is one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients.” Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency, UK

6. What’s the problem?
“Healthcare professionals sometimes try to give verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment. Unless both teams are able to concentrate on the handover of a sick patient, valuable information will be lost.” Junior Doctors Committee, British Medical Association

7. What’s the problem? Information loss Variance ED talking not listening
Not handed over
Not understood
Variance
ED talking not listening
Space issues
Staffing issues

8. What’s the problem? Not just NI ED’s!
Information Loss In Emergency Medical Services Handover
Of Trauma Patients Alix J. E. Carter, Prehospital Emergency Care 2009;13:280–285
4.9 Data points handed over per patient Only 72.9% of these received

9. What’s the problem? Not just NI ED’s!
Maintaining Eye Contact: How To Communicate At Handover Erin Dean. EN1910Mar
Variance in handovers 93% of time ED asked questions – 1/3 already had provided the answers Recommended 20 second hands off time

10. What’s the problem? Not just NI ED’s!
Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient, Sarah Dawson,
 Emergency Medicine Australasia (2013) 25, 393–405
Paramedics - Confident and succinct
ED staff - actively listening
Structure was needed
Repeated handovers leads to information being lost
?displaying the prehospital observations on a computer screen

12. NICE Trauma Guidelines 2015
Record pre-alert information using a structured system and include all of the following:
age and sex of the injured person
time of incident
mechanism of injury
injuries suspected
signs, including vital signs and Glasgow Coma Scale
treatment so far
estimated time of arrival at emergency department
requirements (such as bloods, specialist services, on-call staff, trauma team or tiered response by trained staff)
the ambulance call sign, name of the person taking the call and time of call.

13. NICE Trauma Guidelines 2015
A senior nurse or trauma team leader should receive the pre-alert information and determine the level of trauma team response.
The trauma team leader should be easily identifiable to receive the handover and the trauma team ready to receive the information.
The pre-hospital documentation, including the recorded pre-alert information, should be quickly available to the trauma team and placed in the patient’s hospital notes.

14. NIAS PRF Guidance
At handover, the clinician must provide a structured verbal handover with the accompanying PRF. A format such as ATMIST will facilitate this but staff should also include any other pertinent information e.g. patient medications, use of anti- coagulants, allergies, known conditions etc.

18. What’s the solution? Standardise Proformas Multi-disciplinary buy-in
Team working

19. What’s the solution? Active listening Eye contact
Team leader receiving handover
Move patient – 30 second ‘hands-off’
Don’t interrupt!

22. Take 30 seconds hands off for proper handover
The Plan
Use ATMIST
Take 30 seconds hands off for proper handover
CPR
Haemorrhage control
Compromised airway
Massive transfusion required

23. The Plan