Accreditation practice pointer: managing the handover of patient care
C5.3 A Our practice manages the handover of patient care both within the practice to other members of the clinical team and to external care providers.
RACGP Standards for general practice
General practices need a process for when a patient’s care is transferred from one clinician to another. Clinical handovers occur when:
a practitioner is covering for a fellow practitioner who is on leave or is unexpectedly absent
a practitioner is covering for a part-time colleague
a practitioner is handing over care to another health professional, such as a nurse, physiotherapist, podiatrist or psychologist
a practitioner is referring a patient to a service outside the practice
there is a shared-care arrangement (e.g. a team is caring for a patient with mental health problems)
there is an emergency, such as handover to hospitals or ambulance
the patient makes a request (e.g. to upload their health summary to a shared electronic health record).
When clinical handovers are not completed properly, there can be adverse patient outcomes, such as:
delayed treatment
delayed follow-up of significant test results
unnecessary repeats of tests
medication errors.
It can also result in legal action.
When clinical handovers do occur, it is good practice to:
tell the patient who will take over their care
pass on information about the patient’s goals and preferences
support patients, carers and other relevant parties who will be involved in the clinical handover, according to the wishes of the patient.
Clinical handovers can be completed in person, over the phone, via video consultation or by conveying written information (e.g. in hard copy, facsimile, email or end-to-end encryption platforms).
General practice can manage clinical handovers by maintaining a policy to ensure that standard processes are followed during a handover. The policy could include:
how to use the progress notes in the patient’s health record during a clinical handover
how to have a secure clinical handover when sharing electronic health records (e.g. using healthcare identifiers that uniquely identify the individual patient)
how to give and receive information relating to home visits, after-hours services, hospital discharges and care provided by other healthcare professionals such as specialists
how to record the clinical handover in the consultation notes
how to report near misses and failures in a clinical handover
the use of a buddy system that enables a buddy to follow up results and correspondence and continue the care of the patient when a colleague is absent.
In the event of a clinical handover, practices must keep copies of referrals to allied health services, other practitioners, specialists and ambulance staff in the patient’s health record. Practices also need to have a process for handover of care in the event of unexpected or expected leave.
General practices might also support clinical handovers by:
keeping records of any breakdowns in the clinical handover system that were identified and addressed
using a clinical software program to generate referrals that are automatically populated with a health summary. (The referral must be accompanied by a statement written by the GP giving the reason for the referral.)
having a standard form to be used for ambulance transfers
conducting face-to-face handovers, if possible
maintaining service-level agreements with medical deputising services and after-hours cooperative arrangements, clearly setting out the responsibilities of all parties
using internal messaging or internal email for clinical team members to communicate with each other
using software that has capacity to upload a patient’s shared health summary/record or event summary to the patient’s national shared electronic health record when the patient requests it.