Inpatient Handoffs Between Attending Physicians

Purpose: The purpose of this policy is to ensure that all communication of patient handoffs between attending physicians is standardized, contains accurate information about a patients care, and ensures a seamless transition in management of the patient. A patient handoff is defined as a transfer of care between one caregiver and another (e.g. each evening, before a weekend, at the end of a rotation or between services). Scope: This policy applies to all inpatient handoffs from Attending to Attending physicians. Attending to Attending handoff must occur in the following situations

Change of provider shift and/or coverage on the inpatient service Change in coverage for inpatients and those scheduled for discharge, while out of town

or when unavailable Attending to Attending handoffs must occur in the following situations unless deemed clinically unnecessary by the sending attending:

Admissions from ED to Inpatient services Admission from BWH MD office to Inpatient service of another Attending For all transfers between services for example:

o Transfers from ICU to floor with change of Attending o Transfers from floor to ICU with change of Attending o Transfers from OR/PACU and ICU/floor with change in Attending

Discharges to another care facility Procedure: Direct communication by phone call from Attending to Attending physician is expected for ALL acute issues as deemed clinically necessary (by either the sending or receiving physician) or per existing department policy. For all other situations, email is appropriate with contact information such as cell phone or pager number. When a handoff occurs, it must occur in such a manner to allow for the ability to ask and answer questions. Critical elements in the handoff include but are not limited to the following:

Patient name and medical record number or date of birth Diagnosis History, including date and type of procedure and any operative findings as it applies Anticipated problems and active issues (including expected date of discharge when

necessary, family dynamic, end of life discussion, etc.) Current vital sign abnormalities Code status Covering team

Notes: The Attending physician of record must be notified of any patient admissions or transfer

(Each service is responsible for establishing a mechanism to do this) For direct admissions from the office or another facility, email, LMR Expect Note or a

phone call are all appropriate Attending to Attending handoff communication for discharges can be done with verbal,

email, or letter communication, and should be performed if there are specific issues that need follow up after discharge. This communication is in addition to the discharge summary/orders entered by the house staff or other qualified provider.

Ongoing Monitoring: It will be the responsibility of each Chief to disseminate this policy and respond appropriately to breaches in compliance. Approvals: MSEC 2/08, CIC 12/08 Sponsor: Anthony Whittemore, MD