The Handback Rule – “Lost in Translation”
M. Kooblall, M. Lockhart, R. Dilworth, M. Anwar
Department of Medicine, Our Lady’s Hospital, Navan
Handback refers to the transfer of information and responsibility back from the covering physician to the original physician or team. In most acute Irish hospitals, inpatients under the care of a medical consultant are usually spread out on different wards. Every working day, most medical teams usually print out an electronic inpatient list before starting their ward round. This electronic inpatient list enables the team to locate their patients more efficiently. On a regular basis, patients after a post-take ward round are handed back to different medical teams and their location change as they are transferred to the ward.
At Our Lady’s hospital Navan, if a patient gets readmitted within two weeks, this patient is handed back to the former team.
An audit was carried out at Our Lady’s hospital Navan to assess whether the electronic inpatient list was updated within the next 24 hours from the date of admission. The data of 30 consecutive handback were analysed. Inpatient list of the on-call team and the handback team were monitored. Out of the 30 handback, only 10(33%) were updated on the electronic inpatient list. Furthermore looking at the ward’s station board and patient’s bedside sign, we also found out that 15(50%) handback did not have the consultant name updated.
The main reason why there were such delays was that all electronic transfers were done by the clerical staff and because they have a big workload, this task sometimes gets delayed.
Inadequate handback of information carries significant risks for individual clinicians, their organisations and for their patients. Laboratory and radiology staff faced with a critical result, have difficulty contacting the team responsible for the patient, as they may be different from the team that requested the test. From the perspective of ward staff or lab staff, it is often unclear which team is responsible for their patients, and they have to ‘bleep’ multiple doctors until they find the correct one.
Working from memory may mean that information is not shared or incorrect information is passed on. Use of bed/bay numbers should be avoided to prevent misidentification. The use of unique identifiers prevents confusion in patients with similar sounding names. All hospital patient systems must ensure that administrative data is up to date 24-hours per day. If location and responsible consultant are not accurately recorded and readily accessible this exposes the patients and the hospital to considerable risks.1
Reflecting on the above findings, the medical team and administrative team at Our Lady’s hospital Navan are now working together to ensure that all handback are updated within 24 hours.
Minesh Kooblall, Department of Medicine, Our Lady’s Hospital , Navan
1. Junior Doctors Committee (2003) Making IT work for hospital Juniors: Supporting Working Practices and Training with the New Contract and the EWTD. London: British Medical Association