■ Physician-team:

Leveraging the power of collaboration to foster safe care

Hospital handover by resident

Type of activity: Video

Activity summary

The short video "Hospital handover by resident" portrays a poorly performed handover between 2 residents before a shift change. The facilitation questions and suggestions to faculty focus on helping learners to identify what went wrong, and how to improve the handover.

Transcript

Setting: Nursing station with lots of noise, sound of monitors. Time 4:15 p.m.

Dr. Thomas: Josh, you're on tonight, right?

Dr. Best: Yeah, at 5, and I've still got 2 discharges to do.

Dr. Thomas: Ok well, I'm trying to make it out in time for journal club so I'm going to sign out. 6B who came in this afternoon with abdominal pain. He had some blood work and X-rays but he's booked for an abdominal CT tonight.

Nurse: (interrupting) Dr Thomas, can Mr. Mcknight have something more for his pain? (Dr. Thomas sighs and writes order hurriedly.) His BP is 95/60.

Dr. Thomas: (His pager goes off.) I'm never going to get out of here. Have a good one! (Taps Dr. Best with clipboard and leaves in haste.)

Setting: Resident responds to page in hallway. Time 10:30 p.m.

Voice in background: Dr. Best, call 14928 please. Dr. Best...

Dr. Best: It's Dr Best. You paged?

Nurse: (excitedly on the phone) Dr. Best, Mr. Mcknight is crashing! The ICU team was called.

Dr. Best: Who?

Nurse: Mr. Mcknight in 6B who came in with the abdominal pain. Dr Thomas told you all about him. ICU wants to know his code status.

Dr. Best: (looking puzzled) I have no idea.

Nurse: Well, with his history of cancer ...

Dr. Best: (alarmed) What cancer?

Nurse: And they mentioned something about the free air on his X-rays.

Dr. Best: I thought Dr. Thomas looked at his x-rays!

Nurse: He couldn't have. They weren't even done until after he left.

Dr. Best: I don't believe this! I'll be right there.

Concluding facilitation question: What factors contributed to this poorly performed handover?

Facilitation questions

  1. What could have improved the handover?
  2. What measures could the residents have taken to mitigate risk to patients?
  3. How can a poor handover contribute to a harmful incident (accident in Québec)?
  4. How would you feel if you received this information on handover?

Suggestions to faculty

In small groups, have learners re-write this handover using a structured communication tool and interactive questioning. Have one group re-enact the scenario for the rest of the group.

Additional resources

CanMEDS: Collaborator, Communicator, Professional

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.