Handover of responsibility for the anaesthetised patient – opinion and practice

Abstract

SummaryAnaesthesia is a critical and complex process that extends from the pre-operative assessment through to the postoperative management of patients. Handover of responsibility for logistical as opposed to patient-orientated reasons may compromise that process of care. If such handover becomes inevitable with shift-based patterns of working, the implications need to be considered and procedures developed in order to minimise adverse consequences. This survey of national practice reveals little formalisation of procedure and a spectrum of opinion on the relevance of the key considerations. There is, however, a majority view amongst respondents that national guidelines would be of value and that professional defensibility would be aided by standardisation and documentation of any handover.

A national survey of obstetric anaesthetic handovers*

“…With the pressure of work that exists on the maternity suite, most of it unscheduled, it is important that adequate time is allocated to handover, and it is reassuring that most respondents indicated that this was the case. However, in over half of the units, handover had to take place alongside clinical work, so that concentrating on one, risked delay of the other.The finding that few units had a departmental policy on handover contrasts with recent studies suggesting trainees would find them of value [6,10], and that lack of guidance on handover impedes good practice [10]. The Strongly agree -10 (6%) It would be helpful if OAA could come up with a recommendation that handover includes obstetricians and midwives.…”

“…The finding that few units had a departmental policy on handover contrasts with recent studies suggesting trainees would find them of value [6,10], and that lack of guidance on handover impedes good practice [10]. The Strongly agree -10 (6%) It would be helpful if OAA could come up with a recommendation that handover includes obstetricians and midwives.…”

“…One of the main potential structures for preventing this is good communication during handover [1]. It is during handover, particularly if it is multidisciplinary, that issues can be discussed, leading to a framework for effective patient management.A recent survey of UK anaesthetic departments found that few had structured handover procedures, although most respondents felt that they were needed [6]. However, this survey excluded obstetric anaesthesia, an area of high clinical and organisational risk, and typically one that involves frequent changes of staff.…”

“…A recent survey of UK anaesthetic departments found that few had structured handover procedures, although most respondents felt that they were needed [6]. However, this survey excluded obstetric anaesthesia, an area of high clinical and organisational risk, and typically one that involves frequent changes of staff.…”

“…The report concluded that there were no written procedures for shift handover, the type of information written as notes and communicated at handover was left to the discretion of the operator, and there was no categorisation of important items to include in the handover. Anaesthesia, 2006Anaesthesia, , 61, pages 376-380 doi:10.1111Anaesthesia, /j.1365Anaesthesia, -2044Anaesthesia, .2006 To provide numerical data on the present situation and to assess barriers to the implementation of structured handover procedures that were not in place generally in UK anaesthesia [6], we aimed to survey the opinions of lead consultant obstetric anaesthetists. …”