Purpose

The purpose of this document is to standardise the clinical handover process to ensure that handovers initiated by St John Ambulance WA staff are safe, appropriate and evidence based. Standardisation of handover, as part of a comprehensive, system-wide-strategy, will aid effective, concise and inclusive clinical communication in all clinical situations and contribute to improved patient safety. 

This document is designed to support anyone providing health services on behalf of St. John Ambulance WA where a clinical handover occurs. The use of a checklist in clinical handover designed for the pre-hospital setting is validated by evidence-based practice. This document will also provide information regarding the WA Health Clinical Handover Policy and outlines the minimum set of requirements for all types of handover involving the transfer of patient care between facilities or clinicians. 

Definitions

Clinical Handover is the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis. 

Scope

This process applies to anyone providing health services on behalf of St. John Ambulance WA. It applies in all circumstances where a clinical handover is required

Communicating for Safety Standard

Communication is a key safety and quality issue. To align with the national Safety and Quality Health Service Standards, St. John Ambulance WA have implemented this document to achieve effective, high quality communication of relevant clinical information that is understood and accepted by the receiver when responsibility for patient care is transferred.

Communication at clinical handover

• Handover content should be clear, concise, and use easily understood words with minimal, accepted, abbreviations.
• St John Ambulance recommends the use of the mnemonic IMIST-AMBO when providing clinical handover of the patients in the pre-hospital setting as this is demonstrated to be effective and relevant in this environment and has become the expected structure by emergency departments. 

Interruptions should be avoided during clinical handover. Where interruptions occur it s encouraged to politely advise that you will answer questions when you have finished providing the handover. IMIST-AMBO has two pause points to facilitate questions.

• Within WA health, the standardised structure for all clinical handovers is iSoBAR. It is likely St John WA clinicians will encounter this format when receiving a handover from WA Health staff.
  

Patients of concern

• A patient of concern is a patient that a clinician is particularly concerned about, as defined by the treating clinician. 
• Patients should be handed over in accordance with their severity and clinical risk, as determined by a treating clinician¹.
• Management of a deteriorating patient must be escalated as soon as deterioration in a patient’s condition is detected¹.
• Handover of patients of concern must be documented¹.

Handover between higher skill level to lower skill level

• Clinical staff may encounter circumstances when it may be necessary to handover care of patients in the community to officers of a lower skill level (e.g. Paramedic to EMT, CCP to Paramedic). Such circumstances may include situations such as multiple patients, mass casualty situations or circumstances where the higher level crew is unable to continue provision of care. In the absence of special circumstances the higher level crew/clinical officer are to remain as the primary patient care provider until handover of patient to a health facility or other service provider such as ERHS or RFDS.
• The caregiver must handover all components of care that have been commenced and provided. All information and a care plan should be discussed and documented which outlines any reasonably foreseeable deterioration or side effects of care that has commenced. Paramedics are reminded that once a decision is made to hand a patient over to a crew which is a step down in care, the paramedic carries some responsibility for the outcome of the patient until handover to definitive care for any issues that could have been reasonably foreseen.

Documentation

• All handovers must be supported by a patient care record completed in accordance with the relevant policy.
• An IMIST-AMBO Clinical Handover Checklist may also accompany a patient handover. Where this document has been created it should remain with the patient and be included in the patients hospital notes or discarded in a confidential waste bin if advised by hospital staff.

Key Terms & Links

• Interfacility Transfers