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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