Receiving Handoff
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With rare exception, you are expected to be in-house and ready to take handoff from the on-call team no later than 6:45 am. Please be courteous to your colleagues and be on time. The post-call intern wants to get their work done and go home on time! Wouldn’t you?
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The post-call intern should inform you of any important events overnight, especially if any of your patients became unstable, were transferred to an ICU, coded, or died.
Plugging in your pager
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UIHC:
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After hand-off, call the UIHC operator by dialing 0. Ask them to plug your 4 digit pager number into the overnight intern’s 4 digit pager number. Ask the operator to set the pager to unplug at 7:00am.
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An alternative to calling the operator is to log into SmartWeb and set up the pager to forward to the overnight intern manually.
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Logging to SmartWeb:
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Click Personal Profile and enter UIHC username and password
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Choose Profile underneath Personal Profile
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Select Referral and click New
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Under the Phone Number place the on-call resident’s pager:
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The START TIME will always default to the current time, but this can be changed
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You must enter the END TIME
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Then click Save.
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VAMC:
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Unlike the university, you cannot plug your pager in to the night intern. One person from your team should call all the unit charge nurses and tell them that “white team has handed off for the night”. All pages after this will go to the overnight intern pager.
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Giving Handoff
Updating your Internal Medicine Handoff Report
o Update your handoff every day!
o Make sure that the correct context (i.e Internal Medicine) is listed in the top hand of the hand off report.
o In EPIC: Go to the appropriate patient list, select patient, then choose Write Handoff ⇒ Fill in the boxes entitled Summary, Anticipated Events and To-Do ⇒ Hit the right hand eraser if you want the whole box typing to be deleted ⇒ Hit close and move onto next patient on list ⇒ Print handoff.
o You can write the handoff while a chart is open. Click open a patient’s chart to the information you are looking to write, then click on the icon of a paper and pencil next to the MRN.
o At the VA: Click Tools from the top menu and then click HAND-OFF. Enter your Access Code and Verify Code just as you would for opening CPRS. Click TEAM from the left-hand menu, and then type in IC/Inpatient Team Color (ie IC/Blue). Click on the team name that appears below, and then click SUBMIT. The Hand-off tool automatically saves changes made, but will intermittently delete information that had been entered previously.
o Before signing out, check EPIC/CPRS for any new labs, imaging results or consult recommendations.
What to put in your handoff report
o First Box: Brief summary statement of patient’s co-morbidities and reason for admission.
o Second Box: Anticipated events for each current problem. Please see list of anticipated event examples by organ system in this manual.
o Third Box: List of things for the on-call intern to do. This may include check PM labs, checking fluid balance and giving fluids or diuretics, follow up on important imaging studies that haven’t been read yet and enacting new recommendations from consultants.
o Do not ask the on-call intern to follow-up on something unless the results might prompt a change in management overnight.
o Do not leave procedures for overnight interns.
o If your patient may need a blood transfusion overnight, make sure to obtain patient consult for the transfusion and have and have an updated type and screen on file (expire after 72 hrs).
o If there is a reasonable chance that a patient may die overnight (hospice, critically ill), list the patient’s cause of death on the handoff.
o The overnight events box on the handoff is meant for the overnight intern to write in what he/she did for the patient.
o Examples of handoff scenarios:
When to give handoff:
o As an astute German physician once wrote, Keep in mind that we are not in a clock-punching profession. In other words, do not set expectations that you will always be done at exactly 6 pm.
o Do NOT sign out when you have an unstable patient. This is not only dangerous for the patient but also inconsiderate of the on-call intern who will already have his/her hands full. It is your responsibility to evaluate the patient, find a senior resident or attending to help you, and either stabilize the patient or transfer them to an ICU.
o It is OK to sign out and then complete your progress notes if (1) the on-call intern agrees, (2) the notes are done in a timely manner, and (3) any major changes from the previous day’s note are documented in your handoff report.
o Handoff should be given in a quiet environment with minimal distractions and when each party has enough time to discuss the handoff thoroughly. A rushed handoff may have critical omissions and lead to poor outcomes.
