Since lack of time is a major concern in every hospital, I’m quite amazed how time is wasted during handovers. Anecdotes and stories not only distract us from the important facts but cause major delays.
I am not against a joke or story from time to time, I like a friendly atmosphere at work. But I prefer a focused, concentrated handover and a little bit of smalltalk afterwards, if time allows it.
Over the years I have come to learn that there are 4 main principles for a focused handover. Here they are:
1. Focus on the NEWS.
During many handovers I’m told things I already know. There is no need to regurgitate facts that are known to everybody during every handover. Patients, who have been on the ward for several weeks, should be known to everyone.
If not, present the patient shortly and move over to the PRESENT problem. That’s what the colleagues are supposed to focus on. If they are interested in the whole story, they can read it up later.
There is no need (and no time) to tell old stories, that have no relevance for the upcoming shift.
By the way: If there are no news, quickly move on to the next patient. There is no minimum amount of time per patient that has to be filled during handover. If there is nothing to tell, don’t make up “pseudo-important“ stories.
Too many times the doctors present me facts from last week, just because they don’t have anything new to tell me. That is in nobodies interest. It wastes everybodies time. If there aren’t any new facts don’t tell old ones instead.
2. Use clear language.
When I started to work on the ICU, I made the mistake of using ambigouos vocabulary during my handover. I was very uncomfortable of giving assignments and tasks to my colleagues, so I used phrases like:
- “This patient could probably use a new catheter.”, or
- “The patient has a fever, maybe you get the chance to draw blood cultures.“
This approach only causes misunderstandings and disappointments. So don’t be too cautious with your language. Name the to-dos loud and clear.
3. Disapprove of unnecessary interruptions:
I get impatient very easily when we are interrupted during handover, for one reason:
I hate wasting time.
If four doctors are interrupted time-wasting is multiplied by four! 10 minutes of interruptions equals 1 hour of wasted time! Time that could be spent talking to patients, examining patients, speaking to relatives.
You’ll have to define legitimate reasons for interruptions so your nurses know when it is OK to interrupt you. These may differ depending on the circumstances you work in.
On the ICU these are mainly life-and-death-matters. You can read about how to minimize interruptions here.
4. Minimize drama:
There is always lots of drama during our handovers, that costs enormous amount of time. Try to get to the matter of the problem and focus on the solution. This “Who-said-what and Who-does-she–think-she -is-Crap causes substantial delay and doesn’t help anybody. Just focus on the facts.
Learn to describe certain circumstances with words, not with stories.
Always remember the reason why you want to finish handovers as quickly as possible:
You want to get back to work as soon as possible…