Handing Over

Firstly, what do we mean by “handover” or “present”? It is essentially the process by which you verbally convey important information about a patient to a colleague. So, how do we do this and what should we include? The usual framework used is: SBAR. S=situation, B=background, A=assessment and R=recommendation. This forms the basis for the 5 step approach to a good handover or presentation. Click here for the handover infographic.

Step 1: Patient demographic (name, age & gender) and current condition. 

“I saw a 60-year-old type-2 diabetic gentleman who presented with sudden onset chest pain and is currently alert and well oriented.” This sentence ‘frames the patient’. Framing essentially presents a stereotype of the patient. For example, saying something like “60-year-old life-long smoker with COPD”, primes your colleague to think about relevant diagnoses like infective exacerbation, malignancy etc. 

Step 2: Give an account of the history of presenting complaint (HPC). 

Use the 3x3 HPC Matrix (see previous post) to give a description of the HPC. 

“The chest pain (site) started 2 hours ago (onset) suddenly when walking, lasted for 20 minutes (duration), then progressively got better since (progression), was central crushing and radiated down the left arm and up to the jaw (sort), 8/10 (severity), not made worse (exacerbating) or better (alleviating) by anything, and feels nauseous (associated)”.  

Step 3: Give an account of the relevant background. 

This should include past medical & surgical history (PMH), drug history (DHx), allergies, relevant family history (FHx), brief social history (SHx) and usual status. 

“He has a background of diabetes and hypertension (PMH), takes metformin, gliclazide (sulfonylurea), enalapril (ACE-inhibitor), no known drug allergies (NKDA) (DHx), non-smoker, drinks 10 units a week (SHx) and is usually fit and well”. 

Step 4: Give your assessment of the situation and clinical impression. 

Based on the history, examination findings (see next post), observations (obs), and investigations so far, give you working diagnosis and clinical impression. 

“The history of acute onset crushing chest pain, risk factors, tachycardia, dyspnoea, ST-elevation on ECG, this is likely to be an ST elevation myocardial infarction (STEMI).” 

Step 5: Give a recommendation for next steps of the management. 

“I have started him on aspirin and ticagrelor (anti-platelet), and next steps acutely would be to request emergency PCI (percutaneous coronary intervention).”