Quality statement 4: Structured patient handovers
Adults admitted with a medical emergency have a structured patient handover during transitions of care.
Structured patient handovers between the transferring and receiving teams are associated with improvements in patient experience.
Evidence of structured (verbal and written or electronic) handover processes during transitions of care for adults who have been admitted with a medical emergency.
Data source: Local data collection, for example, ward transfer protocols. NHS England (2017) Seven Day Services Clinical Standards and the Royal College of Physicians (2011) Acute care toolkit 1: handover both include details on patient handover processes.
Proportion of transitions of care for adults admitted with a medical emergency in which a structured handover of care is carried out.
Numerator – the number in the denominator who have a structured handover of care.
Denominator – the number of transitions of care for adults admitted with a medical emergency.
Data source: Local data collection, for example, local audit of patient records.
Service providers (primary, secondary and community-based intermediate care) have processes in place to ensure that during transitions of care a structured handover of care (verbal and written or electronic) is carried out for adults who have been admitted with a medical emergency. The current care provider shares complete and up-to-date care information with the new care provider, who documents and acts on this information. Roles and responsibilities between the current and new care providers are also clearly defined at transferral. Service providers ensure that healthcare professionals have training in structured patient handovers and supervision with monitoring of competency.
Health and social care professionals (such as doctors, nurses, advanced clinical practitioners, physiotherapists, mental health teams and pharmacists) work together to deliver a structured handover of care (verbal and written or electronic) during transitions of care for adults who have been admitted with a medical emergency. They share complete and up-to-date information so that patient safety is not compromised. Roles and responsibilities between the current and new care providers are also clearly defined at transition of care.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that enable coordination and continuity of care, and sharing of information, during transitions of care for adults who have been admitted with a medical emergency.
Adults who have been admitted to hospital with a medical emergency and whose care is being transferred to a different healthcare setting have information about their condition and any special needs passed on to their new care provider. They are given information about their condition and encouraged to be involved in making decisions about their care.
Emergency and acute medical care in over 16s: service delivery and organisation (2018) NICE guideline NG94, recommendation 1.2.11
Acutely ill adults in hospital: recognising and responding to deterioration (2007) NICE guideline CG50, recommendation 1.15
A life-threatening emergency, acute exacerbation of chronic illness or routine health problem that needs prompt action. A medical emergency can arise in anyone, for example in people:
without a previously diagnosed medical condition
with an acute exacerbation of underlying chronic illness
[NICE's guideline on emergency and acute medical care in over 16s: service delivery and organisation, guideline introduction (glossary)]
A handover of care that uses the approach outlined in the SBAR (situation–background–assessment–recommendation) tool to facilitate efficient handover of patients between transferring and receiving teams. It includes:
a summary of the stay, including diagnosis and treatment
a monitoring and investigation plan
a plan for ongoing treatment, including drugs and therapies, nutrition plan, infection status and any agreed limitations of treatment
a discharge plan
physical and rehabilitation goals
mental health, psychological and emotional needs
specific communication or language needs
tasks still to do.
The plan also needs to be communicated to the person or their next of kin.
[Adapted from NICE's guideline on acutely ill adults in hospital, recommendation 1.15, the NHS Institute for Innovation and Improvement's Safer care SBAR implementation and training guide and expert opinion]
When adults admitted with a medical emergency are being transferred to a different healthcare setting they should be provided with handover information that they can easily read and understand themselves, or with support from their next of kin if appropriate. This can help them to communicate effectively with healthcare services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and be culturally and age-appropriate. People should have access to an interpreter or advocate if needed.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.