123

18. Policies and Procedures

Patient Handover Policy


ACGME requirements:
Programs must design clinical assignments to minimize the number of transitions in
patient care.
Sponsoring institutions and programs must ensure and monitor effective, structured
handover processes to facilitate both continuity of care and patient safety.
Programs must ensure that residents are competent in communicating with team members
in the handover process.
The sponsoring institution must ensure the availability of schedules that inform all
members of the health care team of attending physicians and residents currently
responsible for each patients care.

Settings where appropriate Patient Handover must occur:
Patients admitted to Vidant Medical Center from ECU Nephrology Outpatient Clinic or
Outpatient Dialysis.
Patients discharged from Vidant Medical Center back to an Outpatient ECU Nephrology
attending, fellow, or extender.
Patients discharged from Vidant Medical Center back to Outpatient Dialysis.
Hospitalized patients with active issues - from daytime consult or service
fellows/attendings to on-call fellow/attending.
Hospitalized patients with active issues - from on-call fellow/attending back to daytime
consult or service fellows/attendings.
Hospitalized patients transferring between the consult and service teams.
Outpatients with active issues that the on-call fellow/attending need to be aware of.

Expectations for Regular Handovers:
ECU Nephrology fellows/attendings will communicate on a daily basis any appropriate
Handovers to and from the on-call fellow/attending either verbally in person or
by phone, or electronically (e-mail, text page, video conferencing).
ECU Nephrology fellows or attendings at anytime may request a combined handover
which may include multiple fellows/attendings. This may be done in settings of
critically ill patients or issues where any individual feels care will be benefitted by
multiple person/level handover.
Each Friday afternoon, patient hand-over will occur between service/consult attendings
and fellows AND the on-call attending/fellow. In this manner, competency of
fellows in communicating with team members in the handover process may be
assessed and monitored.
ECU Nephrology fellows/attendings/extenders will communicate all hospital discharges
of dialysis patients covered by ECU Nephrology to the appropriate dialysis charge
nurse and extender, and will complete dialysis outpatient orders and fax to the
dialysis unit.
The outpatient dialysis extender and/or dialysis charge nurse and/or outpatient ECU
124

Nephrology fellow/attending will communicate with the appropriate
fellow/attending any patient being sent to the hospital for admission. For patients
thought to be stable for admission to the renal service, the renal service
fellow/attending may be contacted. If the level of care that will be required is
uncertain (renal service vs. ICU and thus renal consult team), the renal consult
fellow will be notified and that fellow will ensure that appropriate team members
are notified as needed.

Friday Afternoon Supervised Handovers:
Minimum information to be transmitted in the hand-over process:
- Utilize the 5 Ps: patient identification, patient data, precautions/code status,
problems/plan, physicians orders
- Fellows will receive immediate direct verbal feedback by faculty regarding
competency with these handovers. Faculty will also document competency of
individual fellow handovers as part of monthly faculty evaluation of fellow.

Schedules:
The monthly call schedules are made in 6 month blocks and are available at least
1 month prior to the beginning of the block. This schedule includes:
- fellow and attending assignments for consults, service, outpatient
- on-call fellow and attending
- designation of which Nephrology group is on call for unassigned
admissions and for plasmapheresis
These call schedules are distributed to all ECU Nephrology fellows, attendings,
and staff; to inpatient and outpatient dialysis and plasmapheresis staff; to
ECU Transplant attendings and staff; to the Emergency Department; to the
ECU Physicians On-Call Answering Service and to the Vidant Medical
Center Refer Direct office.

7/1/11