Standard 6:
Clinical Handover
Suellen Allen, Accrediting Agencies Surveyor Workshop, 11 July 2012
What is Clinical handover
Clinical Handover is the transfer of professional
responsibility and accountability for some or all
aspects of care for a patient or group of patients,
to another person or professional group on a
temporary or permanent basis
Why have a Standard about clinical handover?

Communication problems are a major contributing factor in adverse
events particular during patient transitions of care

Poor or absent clinical handover can have serious consequences:
• delay in diagnosis or treatment
• tests being missed or duplicated and
• lead to the wrong treatment or
• medication errors

Clinical handover is often variable and ad hoc

Information transferred between providers should include relevant
data, be accurate, unambiguous and occur in a timely manor

Structuring handover processes should be standardised to fit the
local context
Evidence base for Standard 6

Research from the National Clinical Handover Initiative Pilot Project

Resources were developed from research to support clinical
handover improvement and the Standard.

The OSSIE Guide was endorsed by Australian Health Ministers as a
national approach for the improving clinical handover

There are principles of effective handover

Evidence supports a structured format (minimum data set and
structure for handover communication) and standardised processes
for conducting clinical handover

There is no one size fits all standard operating procedure – should
be flexible standardisation to fit the local context, setting situation of
handover
Principles of effective handover

Preparing for handover – setting, location and time

Organising relevant workforce

Being aware of clinical context and patient needs

Participating in effective handover resulting in transfer of
responsibility and accountability of care
The Standard
Intention of the Standard:

Ensure there is timely, relevant and structured clinical
handover that supports safe patient care.

Clinical leaders and senior managers of a health service
organisation implement documented systems for
effective and structured clinical handover. Clinicians and
other members of the workforce use the clinical
handover systems.
Three criteria
1.
Governance and Leadership for effective clinical handover
• Health service organisations implement effective clinical
handover systems
2.
Clinical Handover Process
• Health service organisations have documented and
structured handover processes in place
3.
Patient and carer involvement in clinical handover
• Health service organistions establish mechanisms to
include patients and carers in clinical handover processes
1. Governance and leadership for effective
clinical handover
6.1 Developing and implementing an organisational system for structured clinical
handover that is relevant to the healthcare setting and specialities, including:
•
Documented policy, procedures and/or protocols
•
Agreed tools and guides
Why?
Policies, procedure and or protocols should include the documented
structured processes that incorporates the principles of handover relevant to
the setting and context to ensure:

Workforce know the purpose of the handover

Minimum data set and tools required to know and communicate

Workforce know what documentation is required

Workforce is trained and able to participate in agreed handover

Handover is effective resulting the transfer responsibility and accountability
Governance and leadership for effective
clinical handover
Issues

What is ‘structured clinical handover’?
that the minimum data set (information content) and
conduct of handover be delivered in a structured format
to improve patient safety

What is a ‘minimum data set’
• the minimum content that must be contained and
transferred in an individual patient handover
• There are many possible minimum data sets and will
vary depending on the context and reason of the
handover
Governance and leadership for effective
clinical handover
Issues:
 What
structured clinical handover is relevant to the
healthcare setting?
 Needs
to be flexible – depend on:
•
Points of risk during patient transition of care
•
Setting
•
Situation
•
Method
Clinical Handover will vary depending on:
Size of the service, setting and circumstances, including:

The situation of the handover:
• during a shift change
• when patients are transferred inter and intra hospital/service/unit
• during patient admission, referral or discharge

The method of the handover, such as:
• face-to-face
• via telephone
• via written orders

When aided by electronic handover tools

The venue where handover takes place
1. Governance and leadership for effective
clinical handover
What?

Establish and/or review policy, procedures and/or clinical handover
protocols that are relevant to the healthcare setting e.g. different
situations, methods and contexts

Develop/ agree on structured clinical handover tools based on
principles of clinical handover

Train and monitor the workforce in the use of clinical handover
policy/procedures

Implement/maintain the structure clinical handover policy

Develop a system to evaluation/ review clinical handover policies
2. Clinical Handover Process
6.2 Establishing and maintaining structured and documented processes
for clinical handover
Why?

Standardisation and structuring of routine procedures
allows clinical information to be conveyed more efficiently
and with high reliability

Clinical handover solutions must be standardised and fit
for local purpose and appropriate to the clinical context in
which handover occurs.
2. Clinical Handover Process
2. Clinical Handover Process - Issues
Hospital example
If a hospital transfers a patient:
•
•
•
•
to another facility
within the hospital
to oncoming clinicians to the next shift
or is discharged
Handover processes need to be in place for these situations
 Shift
to shift
 Inter
and Intra hospital transfer
 Discharge
Summary
2. Clinical Handover Process - Issues
Day Procedure Centre example
Patient handover situations may include:

Handover between theatre staff with recovery staff

Procedures for handover at discharge to the primary
carer and the patient such as a discharge summary
2. Clinical Handover Process - Issues
Issue participating in effective clinical handover
Tools:

Various tools (ISOBAR, ISBAR, SBAR, SHARED) have
been developed to help structured handover and are
designed to be flexible and adapted to suit local
workforce environments.

Health services can use new tools, or alter available
tools, to develop structured process documentation.

Education resources are available on the Commission
Website
Clinical Handover process
What?

Documented policy for clinical handover based on local needs
including, time management strategies ensuring all relevant staff are
present, organised, educated and prepared for handover

Documented procedures for communication of transfer of
responsibility and accountability

Record of attendance for staff to appropriate training/orientation
regarding standard of content and delivery of clinical handover for
the local setting

Clinical handover tools and policies for all levels of staff
2. Clinical Handover Process
6.3 Monitoring and evaluating the agreed structured clinical handover processes
including:
•
Regularly reviewing local processes based on current best practice in
collaboration with clinicians, patients and carers
•
Undertaking quality improvement activities and acting on issues identified
from clinical handover reviews
•
Reporting on results of clinical handover reviews at executive level of
governance
Why?

Evaluation establish if the policy, procedure and processes is efficient
and determine if changes are needed to optimise performance and to
identify areas for improvement.

Reporting results should be fed back to the relevant committee or
meeting about governance as health service organisation is
responsible for ensuring that their systems for clinical handover are
operational and effective.
2. Clinical Handover Process: 6.3
What?

Identify a suitable individual, group or committee to take on
responsibility for monitoring clinical handover process

Audit of clinical handover/records to ensure staff practices are
monitored and are consistent with policy, process and procedure

Defined role and responsibility to facilitate clinical handover
improvement (if required) and actions relating to evaluation and
monitoring of current practice

Defined process for feed back into executive level governance in
relation to findings on evaluation and monitoring within the local
setting

Agree on strategies for evaluating the clinical handover processes
that includes assessing processes and outcomes
2. Clinical Handover Process: 6.3
Issues

Organisation-wide clinical handover evaluation systems
may already be in place. However, localised workforce
may find it beneficial to establish local project team or
member of staff to oversee, plan and coordinate the
implementation and evaluation of policy, procedure and
process in their local setting.

A localised mechanism to monitor the effectiveness of
clinical handover policy is required to develop quality
improvement processes tailored to individual workforce
and environment which is consistent with best practice
2. Clinical Handover Process
6.4 Implementing a robust organisation-wide system of reporting,
investigation and change management to respond to any clinical
handover incidents
Why?

Monitoring adverse events from clinical handover allow
practices to be modified to further suit local processes
and patient outcomes

Investigation and feedback to the workforce is important
for them to understand the reason for practice change

Evaluation allows measurement of the progress and
impact of the handover process and possible
improvement strategies
2. Clinical Handover Process: 6.4
What?

Establish / confirm incident reporting system that captures
data on clinical handover incidents

Use information from the incident reports to improve
performance

Establishing a mechanism for review and feedback on
clinical handover incidents and actions taken
3. Patient and carer involvement in clinical
handover
6.5 Developing and implementing mechanisms to include patients and
carers in the clinical handover process that are relevant to the
healthcare setting
Why?

The effectiveness of handover communication may be
enhanced by the participation of patients, carers and
family members

Patients involved in their own care, asking questions and
being an active participant in decision making processes
in relation to their condition, results in a reduction in the
risk of the patient experiencing an adverse event
3. Patient and carer involvement in clinical
handover : 6.5
What?

Clinical handover procedure corresponds with the achievement of
other expected outcomes in Standard 2 (Partnering with Consumers)

Evidence of a patient experience survey examining exposure and
feedback of clinical handover scenarios

Evidence of an active mechanism for monitoring and responding to
patient complaints and feedback relating to clinical

Audit of clinical handover processes/documentation to establish the
extent of patient and family involvement in handover discussions
Evidence - 1

Policy and procedure

Documentation of clinical handover

Clinical handover records

Patient care plans

Discharge summaries

Operation reports

Transfer checklist (if appropriate)
Evidence – 2
Workforce Education

Orientation

Policy / protocols

Staff education sessions

Feedback
Evidence - 3

Clinical handover improvement/ Quality activities

Improvement requires time

Change management

Clinician engagement

Requires someone to be responsible for the
improvement activity
Other Issues ?
Resources

Safety and Quality Improvement Guide for Standard 6

Additional material about Standard 6 to follow from the Commission

Implementation Toolkit for Clinical Handover Improvement and
Resource Portal

OSSIE Guide for Clinical Handover Improvement

Jurisdictional programs

Other Australian organisations and resources
Summary

www.safetyandquality.gov.au

suellen.allen@safetyandquality.gov.au