Changing sites: clinical handovers when patients move

In the previous chapters we have seen how patient safety and satisfaction can be put at risk or protected during clinical handover at shift changes. The second most common trigger for a clinical handover is when a patient is moved within or between hospitals. Patients whose conditions warrant further hospital treatment may be moved from the emergency department into a ward – or ‘admitted’ in hospital terminology. They may be moved between wards within the same hospital. They may be transferred from one hospital to another. At each transition point, an effective clinical handover may be what determines whether the patient’s ongoing care will be safe and continuous or risky and disrupted.

The chapters in this section explore the issues, risks and possible strategies clinicians use – and could use – to protect patients. Chapter 8 tracks a single patient being moved between several locations in one hospital across a day and identifies both the risks and the safety mechanisms in the hospital context. Chapter 9 examines the role of written and verbal handover information when patients are transferred from rural or remote locations to a metropolitan hospital and finds a worrying level of inexplicitness, confusion and error in handover documentation. The authors of both chapters suggest protocols and procedures that can be used to better protect patients and improve their quality of care. The protocols are brought together in the integrated iCARE3 model, presented in chapter 15.