Many NHS ambulance services and hospitals now promote the use of ATMIST in patient handover situations, as it facilities a rapid, accurate handover.Patient Handover:
The aim of a handover is to achieve the efficient communication of high quality clinical information at any time when the responsibility for a patient care is transferred. The quality of this handover can have an impact on patient care.
There is significant variation in the quality of handovers from prehospital to emergency department medical teams and the handovers following OHCA is particularly challenging as a lot of information needs to be communicates to the hospital team at a time when resuscitation may be ongoing.
What’s it point?
Professor Sir John Lilleyman, Medical Director, National Patient Safety Agency, UK says “Handover of care is one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients.”
What’s the problem?
According to the Junior Doctors Committee of the British Medical Association healthcare professionals sometimes try to give the verbal handovers at the same time as the team taking over the patient’s care are setting up vital life support and monitoring equipment. They say that unless both teams are able to concentrate on the handover of a sick patient, valuable information will be lost.
We must remember that patient handovers are not only confined to the ED (Emergency Departments) departments. Ambulance also crews attend Doctors and Dental surgeries for patients who need to be transferred to hospital. This is probable the weakest link in the chain as historically, verbal handovers have almost certainly been the main principal of a handover. However, more recently they have been accompanied with a computer print-out of the patients’ history.
This situation is compounded with a GP is making a home visit and the patient condition warrants hospital admission. Some GP’s may have taken a patient medical history computer printout with them. Although this information is valuable but this does not replace the important information required in the handover. This information is called the Chief Complaint.
I clearly remember an occasion when we took patient in cardiac arrest into an ED resuscitation room. I gave a verbal handover to the team. 10 minutes later a ED consultant came in to the room and ask the doctors to repeat my handover, needless to say it was extremely poor for all the reason mention in this article. No active listening and no eye contact had taken place. See below:
Barriers to effective handover
Barriers to an effective handover include lack of structure, duration of handover, gaining the attention of receiving medical staff, lack of training, noise and other distractions, and difficulty recalling important multiple facts and complex information.
Effective handover
1) To aid effective handover, use the ATMIST template to facilitate the rapid transfer of information during resuscitation. Click here to see an example »
2) To use the template correctly keep the information under each of the titles short, clear and concise. To reinforce the structure of each handover section, announce the titles before the section information. Consider using a written template and practice your handover prior to hospital arrival.
3) Speak loudly and clearly using the template heading: pauses will enable important points to be understood and assimilated. Be concise and try and limit the handover. Adjuncts to handover such as pictures from the scene can be extremely useful. If you have taken them, show them to the hospital team leader.
References:
Resuscitation Council (UK) 2015 Guidelines, 4th Edition Jan 2016 ISBN 978-1-903812-31-0
Dr Davy Green Online slide presentation: NIAS-CPD-ATMIST-1.pptx
You may also like our article on NEWS2 in our Medical Training section.
