Joint clinical handover

Clinical handover between staff is a constant staple of our professional lives.

The quality of that handover, and critically the information that is imparted, is key to the patients remaining care in the Emergency Department. If the correct information is handed over then good quality care will continue for the

remainder of he patients four hour stay.

The inter-shift handover is probably the most important of the day for all clinical staff, where not only are the patients currently in the department

handed over, but other key issues such as estate problems, outstanding requests, and pathway or process issues are as well. There has been significant writing in the nursing press about inter-shift handovers on the ward area, with a lot of focus on its location, normally either at the bed side or in the ward office, but little has focused on the ED, and our environment is not the same.

Being one of the few areas of the hospital that truly works together with our medial colleagues twenty four hours a day brings about its own unique handover requirements. For example issues with process or estates are as

relevant to the medical team in the emergency department as they are to the

nursing staff.

Some individuals will argue that there are specific nursing issues that require

a separate handover. However in the Emergency Department the nursing

assessment is just as relevant to the medical staff as the medical plan of

treatment is for the nursing staff. The most obvious way to handover information that is relevant to both professional groups is through a joint clinical handover. By undertaking a joint

handover at the start of shift, everyone who is starting can hear the same clinical details. There is the opportunity for learning as the junior doctor presents their patients to the consultant at the handover, whilst patients who are waiting to be seen are presented by the nursing staff.

From a senior management perspective it is useful to have all the nursing and

medical staff in one place. Key issues effecting the department can then be

handed over to everyone at the same time. It allows consultant engagement

with the nursing workforce, and senior nursing engagement with the medical

workforce, producing a cross pollination of learning. In this way problems or jobs in the department do not become labelled as “nursing” or “medical”, they

becomes issues for the department, that all are involved in addressing.

The key to undertaking a joint clinical handover is the structure that you use.

Without structure to the handover different professional interests and issues

arise and any focus and benefit to the handover is lost. A large space without

interruptions is also useful, either at the back of the clinical area, or in a training room. 

One of the benefits of undertaking this handover in an administrative or other

quite area is the potential to turn it into a power point presentation, and this can help to ensure that everyone follows the standard format during every handover. With a power point presentation it also allows flexibility for the senior management team to add key current issues to the presentation. This allows them to impart key current information that is topical for that week to all the staff, as individual emails are sometimes poorly read.