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Handovers


Transferring care to others

Overview and objectives


Elderly patient
Elderly patient with a hip fracture
Mrs. Thomas is a 76-year-old patient with a history of diabetes who is on anticoagulants for atrial fibrillation. She is seen by her family doctor after she suffers a fall.

Suspecting a hip fracture, the physician transfers Mrs. Thomas to the emergency department where this suspicion is confirmed.

Clinical events
Prior to surgery, the anticoagulants are stopped and low molecular weight heparin (LMWH) is started.

During a complicated course in hospital she is cared for by many healthcare providers.

Transfer of care
Two weeks after surgery, Mrs. Thomas is to be transferred to a community convalescent centre. A new resident just starting her rotation in orthopaedics is asked to write the discharge prescriptions. The resident stops the LMWH, assuming it had only been prescribed for post-operative deep vein thrombosis (DVT) prophylaxis.
Outcome
The need for restarting the anticoagulants is not recognized during the review of the medical record. Unfortunately, Mrs. Thomas suffers a fatal thromboembolic stroke 2 weeks later.
Think about it
How could the transfer of care have been improved?
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Objectives

After completing this topic you will be able to:
  • Discuss the importance of handovers.
  • Identify 6 barriers to performing effective handovers.
  • Discuss 4 strategies for improving handovers.
  • Identify 3 communication techniques to use during handovers.