“That's all I got handed over”

Editor—We share Sithamparanathan's views of the importance of handover.¹ Between December 2005 and January 2006 we carried out a telephone survey of house officers on call in general surgery in the 17 hospitals in Wales.

In six hospitals there was no allocated place for handover. In none of the hospitals was handover bleep-free and uninterrupted. Allocated handover time was no longer than 30 minutes in 16 hospitals and no longer than 20 minutes in 11. A handover proforma providing a minimum of information (outstanding investigations, outstanding patient reviews) had been developed in only two hospitals. Personal lists were used in most hospitals (13), with the potential of patients being lost if the list is mislaid. Six house officers never and five only sometimes received feedback of their management decisions at handover. Eight of them never or rarely presented to the consultant on call.

The potential benefit to the patient of being treated by less tired doctors who work in shifts is offset by information breakdown due to poor handover, rendering the system prone to misses and near misses.

We favour a post-take bedside ward round not only from a medicolegal point of view but also as an opportunity for bedside teaching and learning by giving feedback to the outgoing team. The leadership of senior doctors in the handover process would be of great benefit. Rotas may need to be adjusted to allow sufficient overlap between junior doctors' shifts and senior doctors' working days.