High Quality Handovers

Christine Hamilton

---

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

• Should be very specific, and instructions should contain the time a task should be performed, the task itself, and actionable recommendations. For example: "21:00 -- Follow-up intake/output. If urine output is less than 2L, order 160mg IV Lasix."

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.

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