Clinical Handover in Context: Risks and Protections Across a Hospital Patient’s Journey

De Gruyter Mouton
Publication Type:
Effective Communication in Clinical Handover from Research to Practice, 2016, pp. 131 - 155
Issue Date:
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One weekday afternoon an 18-year-old patient, we’ll call her Belinda Page,1 arrives at the emergency department of a busy tertiary teaching hospital, complaining of shortness of breath and chest pain due to a flare-up of her asthma. During the six hours Belinda spends in the emergency department she develops additional symptoms – weakness and numbness, particularly down her left side. She undergoes an emergency MRI, x-rays and other tests but the emergency department night registrar, Dr Ken Lee – a relatively junior non-English speaking background doctor – cannot reach a diagnosis. Under pressure to move patients out of the emergency department as quickly as possible, during the night he calls the senior neurology consultant, Dr Richard Lancer, who declines to admit Belinda before reviewing her. Dr Lee then calls the Ward M consultant, Dr Allenanda, who reluctantly agrees to admit Belinda to a general medical assessment ward, until the neurology staff can review her the next day. Over the next day we observed and recorded as many of the interactions with and about Belinda as we could, including consultations and examinations, formal and informal discussions about her case and nursing and medical handovers. The first occurred at 8 am the next morning when, after working a 12-hour shift, Dr Lee fronted up to a large auditorium to give the whole-of-hospital medical handover of all the patients he had admitted overnight. He sat on a solitary chair placed front and center of the auditorium, almost as if he were to be interrogated. In the tiered rows of seats facing him sat those members of the hospital’s day shift medical staff who had the time and motivation to attend (attendance is not compulsory). On this morning, about 25 doctors were present, ranging from interns to senior consultants. They included the two female registrars from Ward M (Dr Pantani and Dr Lingren) and a male cardiology consultant (Dr Davidson). The neurology consultant Dr Lancer arrived about five minutes into this handover. While Dr Lee delivered his handover, referring to a sheet of handwritten notes, another doctor stood at the computer console, front right of the auditorium, and projected the patient’s x-ray, test results and scans on the front screen. Below we reproduce a transcript of this five-minute handover.
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