In my previous post, I stressed using a structured process to hand off information between the overnight trauma team and the incoming day providers. There is one more very important handoff that occurs in most centers as well: the afternoon handoff. This involves the transition between the day team, who received the morning report, and the trauma professionals who relieve them in the late afternoon or early evening.

This handoff is not nearly as involved as the morning one. Hospitals are structured to be very busy during the morning and afternoon shifts, and activity then tapers off in the evening and at night. However, a smooth transition of personnel is essential to ensure seamless patient care.

Following is the list of items I think are essential for that afternoon handoff:

1. Introductions. This may not be necessary because the afternoon team is typically smaller than the morning report team, and the players typically know each other well.
2. Urgent issues. This is a list of critical events that need to be addressed soon or immediately. These are typically much less common in the afternoon, but may still occur.
3. Pending transfers in. The day team should list any scheduled transfers in from outside hospitals that have not yet arrived.
4. Existing patient lists.  The service lists should be run at this point. Any pending work or tasks not completed by the day shift should be listed so they can be seamlessly picked up by the relief team.
5. START THE EVENING!!

Just like morning report, this handoff should be conducted at a set time and place to develop consistency. It also allows all players to adhere to any overtime or work hour restrictions.

If your center includes other items on these checklists that you find helpful, please email or leave a comment below.

Click here to read the morning report best practice post

Trauma professionals are immersed in patient care for a significant portion of their workday. They accumulate and process a lot of information about many patients during that time. But at some point, they actually get to go home!

What happens to all that knowledge from their workday? It must be shared to provide good continuity of care. So ideally, it is passed on to the team coming in to relieve them.

Many trauma centers have adopted some form of “morning report” to share knowledge from the outgoing night team with the incoming day team. In my experience, many of these meetings are relatively unstructured. They work, but they could be more effective/efficient.

A “best practice” for the morning report is to systematize it so it always includes all the key items needed for the shift transition. The best way to accomplish this is with a checklist. Pilots use these to make sure they don’t forget key tasks, such as lowering the landing gear at the right time. The same thing applies to the trauma morning report.

Here is a list of what I consider to be the key items to include in your morning report:

1. Introductions. This is a quick round of self-introductions, with names and roles. In many trauma centers where the team is small and everyone knows each other, this step may be unnecessary. However, larger centers with large teams or frequent rotations on and off the service will definitely benefit from this step.
2. Urgent issues. This is a list of critical events that need to be addressed soon or immediately. This could be a patient who just started crashing. Some members of the incoming team may need to leave to deal with these situations.
3. Pending transfers in. The night team should describe any transfers they have accepted, with a summary of the patients and their known needs upon arrival.
4. Patient phone calls. If any patient calls (i.e., from previously discharged patients) were relayed to the overnight team by the call center, these should be detailed so the a member of the day team (MD or RN as appropriate) can follow up as needed.
5. New patient summaries. All new admissions should be presented briefly, including mechanism of injury, pertinent exam finding, workup completed, diagnoses, further studies needed, and the proposed treatment plan.
6. Existing patient lists. Service lists should be run, and any patients that have needs that must be taken care of before rounds should be noted. Examples include a serial abdominal exam or a wound check if a possible infection is suspected.
7. Discharge list. Hopefully, discharge planning has been ongoing during each patient’s stay. All patient discharges planned for the day should be noted so they can be examined early by a team member to ensure they are on track for leaving the hospital early in the day.
8. Team assignments. This depends on the size of the service and the number of teams. Some personnel may be assigned to a specific service. Some may be directed to go to the OR, the ICU, or cover the clinic.
9. START THE DAY!!

Ideally, morning report should occur at the same time every day of the week, every day of the year. Most tend to start between 6 and 8 am. If emergencies occur and morning report is interrupted, key personnel should tend to the acute problem and any remaining members continue with morning report. As soon as the emergency has ended, the incoming team members should reassemble to complete the checklist. In some situations, it may be more convenient to continue this at rounds. But be sure to cover all key items as early as possible.

Click here to read the afternoon handoff best practice post