Background
Receiving a handover
A patient handover involves transferring care responsibilities for a patient, either temporarily, or permanently, to another individual. Communication errors are a significant cause of adverse events, often due to missing patient information or a lack of structure in presenting them.
The Situation, Background, Assessment, and Recommendation (SBAR) acronym is widely used in healthcare to convey patient information effectively and concisely. It offers a structured way to communicate between healthcare professionals and is also helpful in urgent situations or scenarios with hierarchical differences.
Apart from handing over to other colleagues, it’s crucial to know what information to seek when receiving a handover. This ensures you are well-informed about a patient’s current status and necessary tasks.
OSCE Tips and Scenarios
OSCE Scenarios
Some OSCE scenarios require you to receive a handover, using the SBAR framework. This scenario might involve another clinician in a rush to leave, wanting to quickly hand over two patients to you. The actor may be instructed to pressure you to finish quickly and may not readily share information. This is to test your ability to ask the right questions politely.
In these scenarios, one patient is more unstable than the other, and you will have to ask the right questions to decide who will be seen first. You will be given a piece of paper to take notes and at the last minute, the examiner will ask you which patient you would see and why, testing your prioritisation skills. These stations test:
- Your skills of asking the right questions when receiving a handover.
- Accurately determining the clinical stability of each patient and which to prioritise.
- Your communication skills with colleagues.
Mistakes that people make
Receiving a handover when the other person is unfamiliar with SBAR or not willing to share information can be difficult, but this can be made easier by familiarising yourself with the SBAR format. Not knowing what questions to ask or being disorganised can increase the risk of important information being missed and possible adverse outcomes. Mistakes often made include:
- Collecting handover information in a disorganised/unstructured manner.
- Being unable to differentiate between relevant and irrelevant information.
- Uncertainty regarding requests from the other person or being unclear about this.
- Being unable to prioritise and justify which patient to see first.
Tips for the station
Remember this is a simulated scenario: simulated colleagues may act obstructive or frustrated. Ultimately, this is a simulated scenario and even if it were real, you are taking over patient care and it is more important for you to know everything needed to avoid potential harm.
Split the page in half, collect information about each patient one by one, and prioritise during the station, not at the end: doing this ensures that when you are starting to collect information about the second patient, you can use the first patient’s information as cues to remember what to ask. You should also try to compare them as you collect the second patient’s information to help with deciding which patient is seen first. If you can’t identify any clear distinguishing factors, you might need to ask some further questions. For example, a patient admitted with acute psychosis who has been sedated vs. a patient with deliberate self-harm. You would need to ask if either patient is at risk of hurting themselves or someone else now.
Ask broad questions, but not too broad: asking about everything can be difficult in such a short timeframe, however, asking an umbrella question followed by narrower questions can be helpful. For example, instead of asking for the pulse, then respiratory rate, then blood pressure etc., you could ask “Has anyone measured their observations? What are they?” and ask for them all. However, this requires a balance because you cannot just ask “Has anyone assessed the patient?” as this is too broad and you most likely will hear back “Like what?”.
If the colleague hasn’t done something, it doesn’t mean no one has: for example, if you ask if the colleague has examined the patient and they say no, this doesn’t mean no one has. A better way of asking this would be “Has anyone done a cardiovascular examination on this patient yet?” because this avoids needing to ask a second follow-up question if the colleague says they haven’t. In this case, the actor doesn’t really have a choice other than saying “yes” or “no”.
Don’t over-focus on numbers like NEWS scores. Consider the whole clinical picture: not every scenario will have a patient with a NEWS score of 1 vs. 5 and depending solely on numbers such as NEWS scores may risk missing key information or ending up seeing the wrong patient. If a person were to run up some stairs before an appointment and have their pulse measured, they could easily score 1-2 on a NEWS chart due to a higher pulse and this does not mean they are unstable. Use the whole picture and don’t be thrown off if there’s no gigantic difference between the patient’s NEWS scores.
Summarise and clarify: if you have time in the end, try to briefly summarise and clarify information about the patients, to double check you have everything you need.
Be polite and remember this is a human interaction: don’t dive straight into collecting information. Build rapport and thank them for staying behind. This could help make the station feel less stressful and may make the actor nicer.
Approach
Introduction
- Introduce yourself: with your full name, role, and location.
- Confirm who you are speaking to: including their full name, role, and location.
- Build rapport: (e.g. ask them how they are doing)
- Explain the purpose of the discussion: “I believe you’d like to hand over some patients to me?”
- Ask for an overview: ask for a quick overview of each patient.
In some stations, actors may be instructed to pressure you into letting them leave early. Do not let them go until you have had a sufficient handover – tell them you will try to be as quick as possible. Ask them to stay for a little longer so you can get what you need and thank them.
Situation
Start by signposting that you’d like to start with one patient first. Go through each patient one by one and collect:
- Patient information: their name, date of birth, sex, NHS number, and location (e.g. what ward they are on). This is important as some people can have the same names and dates of birth.
- Current problem and timeline: ask what is going on and over what timeframe, e.g. “This patient presented with acute chest pain and started deteriorating 10 minutes ago”.
Background
You are not expected to take an entire history, but ask about:
- Current problem history: relevant components about the events leading up to now. For example, how long it has been, how they got here (e.g. via ambulance), and a summary of what has happened since (e.g. treatment given, tests taken etc.).
- Ask if a complete history has been taken: the colleague may say that they have not yet had a chance to see the patient, however, it is always good to ask this. Consider if a collateral history may be needed and ask about this (e.g. seizures, falls etc.) and ask if any witnesses came in with the patient.
- Past medical history: relevant components about the patient’s past medical history.
- Past surgical history: relevant for perioperative scenarios.
- Drug history and allergies: including what happens during the reaction.
- Relevant social history: ask about information that is likely to change the patient’s assessment and management. For example, an elderly person presenting with a fall who lives alone, has visual impairments, and is struggling with their activities of daily living.
Assessment
Collect relevant information about assessments and use a mini-ABCDE approach to help. Start with relatively broad questions before asking more narrow ones, for example instead of asking “Do they have any wheezing?” try asking “Has anyone done a respiratory examination and were there any signs?”:
- Overall impression: ask about how the patient is doing and how they feel about the patient overall.
- Stability and observations/vital signs: ask for their observations and NEWS score. They may ask which ones, say all of them: this includes NEWS score, pulse, respiratory rate, blood pressure, oxygen saturation, temperature, and Glasgow coma/ACVPU score and gives a good idea of how stable the patient is.
- Airways: are their airways patent?
- Breathing: any respiratory examination findings or test results?
- Circulation: any cardiovascular examination findings or test results?
- Abdominal: any examination findings or test results?
- Disability and neurology: any examination findings or test results? Never forget glucose.
- Postoperative status: any relevant findings? Such as the appearance and status of any wounds, drains, lines etc.
- Exposure and everything else: any relevant findings?
- Relevant tests: ask about relevant tests that have been performed, their results, and what is being awaited. Where possible, try to group them, e.g. “Has anyone done any routine blood tests such as their full blood count, urea and electrolytes, liver function tests etc.”.
- Relevant treatment: ask what has been done so far and what is likely to happen.
- Problems needing addressing: what else needs doing?
- Working diagnosis/current problem: ask if they have a working diagnosis.
Recommendation
Ask about the following:
- Management plan: what is the patient’s current management plan?
- Recommendations/request: what would they like you to do?
- Urgency and timeframe: do they need anything done within a specific timeframe?
- Summarise and clarify: confirm key details about each patient and clarify what is being asked of you.
- Invite them to ask questions: is there anything else they’d like to ask?
- Provide them with contact details: encourage them to get in touch if needed
- Thank them for their time: remember that the recipient is a human being and be polite.
