Letters
General medicine
Volume 184 - Issue 9

Medical handover

Authors:  Francis J Bowden, Christian Lueck, Mark Hurwitz and Karina Kennedy

Med J Aust 2006; 184 (9): 477-478. || doi: 10.5694/j.1326-5377.2006.tb00332.x
Published online: 1 May 2006
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To the Editor: We were interested to note that the evolution of morning handover at Launceston General Hospital, as described by Fassett and Bollipo,1 closely parallels our own experience at the Canberra Hospital, and we endorse their points about running a successful meeting. Our hospital has a large Geriatric Unit and all subspecialties are covered, but we do not have a general medicine unit.

In 2002, we began a formal morning handover meeting from 08:00 to 08:30 for junior medical officers (JMOs) in the Department of Medicine, with the initial intention of providing an opportunity for Royal Australasian College of Physicians (RACP) basic trainees to present cases they had seen overnight. Scrutiny of the individual’s clinical approach by consultants, in preparation for the RACP examination, was the main emphasis, and “interesting” cases were chosen. The meeting was also used for case presentations by specialty units. Attendance was variable, and many junior staff reported feeling somewhat threatened by having their patient management approach examined in a public forum.

Handover of most newly admitted patients did not occur during this meeting. The format was incrementally modified over the following 3 years so that, by 2005, the meeting had become a formal handover of all patients admitted during the previous evening and overnight.

Attendance is now compulsory (except for staff attending medical emergencies), and breakfast of brewed coffee and tea with fruit and muffins is provided (funded by the Canberra Hospital). We have over 40 daily attendees (comprising registrars, residents, interns, medical students and 5–10 consultants). We have minimised the number of specialty presentations: these now usually take the form of “red flag” sessions, in which a specialist unit highlights areas of common and/or life-threatening importance (eg, a patient with unstable angina needs admission, regardless of their troponin level; recurrent rigors in a middle-aged person usually signal a bacterial infection).

A survey of 57 of the attendees this year revealed that over 90% thought the format and duration of meetings and attendance by consultants was appropriate; 54% and 39%, respectively, said they learned new information every day or every week. Over the past 4 years, the handover has become embedded in the clinical culture of the hospital. The long-term commitment of a small group of consultants has demonstrated that this is a safe and encouraging environment for clinical teaching, and the level of discomfort of the JMOs appears to have receded. The morning handover has been an important means of ensuring that young doctors are exposed to a broad perspective on patient care and that their after-hours patient care can be supervised.

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