HLTH 3105 Week 3 Clinical Handover Rewrite Example

Two Versions of One Handover: A Weak Nurse-to-Case-Manager Transfer, a Rebuilt Version in a Structured Format and What the First Left Out

Student Name

Walden University

HLTH 3105: Interprofessional Teamwork in Healthcare

Instructor Name

Month Day, Year

Two Versions of One Handover: A Weak Nurse-to-Case-Manager Transfer, a Rebuilt Version in a Structured Format and What the First Left Out

The Situation

At 1500, a bedside nurse on a medical unit stops a nurse case manager in the hallway to hand over a patient she expects to be discharged the next morning. He is 68, in for a COPD flare, married, and did not use oxygen at home before this stay. The case manager will arrange services overnight and in the morning. The conversation takes about 40 seconds. This paper reproduces the handover as it happened, a composite drawn from conversations I have overheard as a discharge coordinator assistant, then rebuilds it in a structured format and lists what the first version left out, with the decision each omission would have changed.

Version 1: The Weak Handover

"Hey, Mr. Dorsey in 14 is probably going tomorrow. COPD, he's a lot better. He might need oxygen, RT was looking at him. Wife's at home. Can you set him up?"

Version 2: The Rebuilt Handover in I-PASS Format

Structured handover formats reduce omissions by giving the speaker a fixed order. I-PASS, developed for physician handoffs, walks the speaker through severity, a brief history, pending tasks, likely changes with a backup plan, and finally the listener's own restatement; when hospitals adopted it, researchers found fewer errors and fewer avoidable harms (Starmer et al., 2014). The format adapts well to a nurse-to-case-manager handover about discharge.

Illness severity. "Mr. Dorsey in 14 is stable, improving, expected to discharge tomorrow if his oxygen holds."

Patient summary. "Sixty-eight, COPD flare, day four. Off IV steroids since this morning, on oral prednisone. On two liters by nasal cannula at rest, saturating 92%. Was on room air at home before this admission."

Action list. "Respiratory therapy did an ambulatory oxygen test at 1300; it's in the flowsheet, and he dropped to 86% on room air walking, so he'll qualify for home oxygen. He'll need a home oxygen order from the physician, a vendor, and delivery before he leaves. He also needs a follow-up with pulmonary within a week, which isn't scheduled. Pharmacy flagged his new inhaler as needing prior authorization."

Situation awareness and contingency. "His wife has mild dementia, so she can't manage the oxygen setup. The daughter, who lives nearby, has promised to come at 1000 tomorrow. If the oxygen can't be delivered before discharge, he can't go home on room air, so either delivery happens in the morning or he stays."

Synthesis by the receiver. The case manager repeats: "So, qualifying oxygen result is in the flowsheet, I need a physician order and a vendor tonight, delivery by 1000 with the daughter there, pulmonary follow-up within a week, inhaler authorization. Wife can't manage equipment. If no delivery, no discharge." The nurse confirms.

What Version 1 Left Out

Each omission below is paired with the decision it would have changed.

The oxygen test result and where to find it. Version 1 said only that respiratory therapy "was looking at him." Without the result, the case manager cannot start the order and vendor process that evening, because coverage depends on documented qualifying values. Decision changed: whether arrangements start tonight or tomorrow morning, which in turn decides whether discharge happens on time.

The current oxygen requirement. "He's a lot better" does not say he is still on two liters. Decision changed: whether the case manager treats oxygen as possible or certain.

The wife's dementia. "Wife's at home" suggests a caregiver. Decision changed: who must be present for equipment delivery and teaching, and whether the daughter must be contacted.

The daughter's availability. Not mentioned. Decision changed: the delivery time requested from the vendor.

The follow-up appointment and the inhaler authorization. Not mentioned. Decisions changed: whether these tasks are done before discharge or discovered afterward, when they are harder to fix.

The contingency. Version 1 implied discharge was likely. Decision changed: whether the case manager warns the physician and charge nurse tonight that discharge depends on a morning delivery.

A read-back. Without synthesis, neither nurse knew whether the case manager had understood. Decision changed: nothing directly, but every error above would have gone undetected.

Using the Format on a Busy Unit

A structured format only helps if staff use it when they are rushed, which is exactly when they are most tempted to skip it. Three habits make it more likely. First, handovers about next-day discharges happen at a set time, such as 1430, at the nurses' station rather than in hallways, so both people expect them and have the record open. Second, a short card with the five headings sits at each workstation, so nobody has to remember the order. Third, the case manager asks for the read-back step even when the nurse forgets, so the habit belongs to both roles.

None of this requires new technology. The point is to make the complete handover easier than the incomplete one, so that the 40-second version becomes the exception rather than the norm.

What the Rewrite Costs and Why It Is Worth It

Version 2 takes about two and a half minutes instead of 40 seconds. On a busy afternoon, that is real time. But the omissions in Version 1 would each have cost more: an evening lost for the oxygen order, a discharge delayed past noon, an inhaler that could not be filled after the patient got home, or a wife left alone with equipment she could not use. Poor information transfer at transitions of care is a well-documented source of problems after discharge, including missing follow-up plans and pending test results (Kripalani et al., 2007).

The format also changes who carries the burden of remembering. In Version 1, the case manager would have had to ask the right questions, and in a hallway conversation she would likely not have asked them all. In Version 2, the structure asks them. Reviews of interprofessional collaboration point to shared routines like this, rather than goodwill alone, as one of the more promising ways to improve how teams work, though the evidence is still developing (Reeves et al., 2017). The case manager's read-back closes the loop, so the nurse knows the message arrived. A handover is complete not when the speaker stops talking but when the receiver can say back what will happen next.

References

Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841. https://doi.org/10.1001/jama.297.8.831

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2017(6), Article CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556