Entrustable Professional Activities

EPA 5: Handover of care

EPA 5

Handover of care

Manage the handover of patient care between health professionals, providers, and contexts

This activity requires the ability to:

  • manage a transition of patient care to ensure the optimal continuation of care between providers
  • identify the appropriate health care providers and other stakeholders with whom to share patient information
  • exchange pertinent, contextually appropriate, and relevant patient information
  • work flexibly between settings, including emergency departments, acute, subacute, outpatient, and community/home visits
  • recognise clinical deterioration and respond by following the local process for escalation of care.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a goal-based, patient-centred approach to facilitate patients' optimal level of functioning and participation in society
  • follow-up patients once discharged, where required
  • facilitate optimal handovers for patients
  • identify and manage key risks for patients during handovers
  • anticipate possible changes in patients' conditions, and provide recommendations on how to manage them
  • provide rehabilitation care during all stages of care, including ICU, acute, community, and ambulatory care
  • manage overlaps in care, including paediatric transition to adult medicine
  • recognise immediate life-threatening conditions, deteriorating and critically unwell patients, and respond appropriately
  • conduct risk assessments at admission, determining acute complications that may arise recognise patients' instability/level of stability and manage according to resources available, seeking help where required
  • conduct accurate risk assessments in a collaborative manner, and recognise the early need for transition of care to higher dependency settings
  • adapt care as the complexity, uncertainty, and ambiguity of patients' clinical situations evolve

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • understand the details of patients' conditions, illness severity, and potential emerging issues, with appropriate actions
  • provide accurate summaries of patients' information with accurate identification of problems or issues

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • write relevant and detailed medical record entries, including clinical assessments and management plans
  • write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
  • initiate and maintain verbal communication with other health professionals when required
  • communicate with patients, families or carers about transition of care, and engage and support these parties in decision making
  • explain acute situations to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate clearly with clinicians and other caregivers
  • use standardised verbal and written templates to improve the reliability of information transfer and prevent errors and omissions
  • communicate accurately and in a timely manner to ensure an effective transition between settings, and continuity and quality of care

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • identify patients at risk of a poor transition of care, and mitigate this risk
  • maintain up-to-date certification in advanced life support
  • use electronic tools (where available) to securely store and transfer patient information
  • use consent processes, including written consent if required, for the release and exchange of information
  • demonstrate an understanding of the medicolegal context of written communications

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • ensure that handovers are complete, or work to mitigate risks if a handover was incomplete
  • ensure all outstanding results or procedures are followed up by receiving units and clinicians
  • keep patients' information secure, and adhere to relevant legislation regarding personal information and privacy

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • integrate clinical education in handover sessions and other transition of care meetings
  • tailor clinical education to the level of the professional parties involved
  • seek guidance and feedback from health care teams to reflect on encounters and improve future patient care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • take opportunities to teach junior colleagues during handovers as necessary
  • provide constructive feedback to junior colleagues to contribute to improvements in individuals' skills

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • evaluate the value of treatments in terms of relative and absolute benefits, cost, potential patient harm, and feasibility

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • refer to evidence-based clinical guidelines and protocols on acutely unwell patients
  • use information from credible sources to aid decision making

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • communicate with careful consideration of health literacy, language barriers, and culture about patient preferences and whether they are realistic and possible, respecting patient choices
  • recognise the timing, location, privacy, and appropriateness of information sharing with patients and their families or carers

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • include relevant information regarding patients’ cultural or ethnic background in handovers, and whether an interpreter is required

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • disclose and share only contextually appropriate medical and personal information
  • demonstrate understanding of the clinical, ethical, and legal rationale for information disclosure
  • share information about patients' health care in a manner consistent with privacy laws and professional guidelines on confidentiality
  • demonstrate understanding of the additional complexity related to some types of information (e.g. genetic information or blood-borne virus status), and seek appropriate advice about disclosure of such information
  • interact in a collegiate and collaborative way with professional colleagues during transitions of care
  • advise colleagues of patients' wishes to refuse medical therapy, including life-sustaining treatment
  • facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • maintain respect for patients, families, carers, and other health professionals, including respecting privacy and confidentiality
  • communicate patients' wishes and preferences about care

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • ensure patients' care is in the most appropriate facility, setting or provider
  • recognise the need for escalation of care, escalating to appropriate staff or service
  • demonstrate an understanding of the pathophysiological sequelae of the conditions of patients undergoing rehabilitationpriate facility, setting, or provider

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • use a structured approach to considering and prioritising patients' issues
  • recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate multidisciplinary teamwork, with the patient at the centre
  • share the workload of transitions of care appropriately, including delegation
  • demonstrate understanding of the medical governance of patient care and the differing roles of team members
  • show respect for the roles and expertise of other health professionals, and work effectively as a member of professional teams
  • ensure that multidisciplinary teams provide opportunities for patients' engagement and participation when appropriate

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise factors that impact on the transfer of care, and help subsequent health professionals understand the issues to continue care
  • work to overcome the potential barriers to continuity of care, and appreciate the role of handover in overcoming these barriers

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • contribute to processes for managing risks and identifying strategies for the improvement of transitions of care
  • engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital dischargess

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • factor transport issues and costs to patients into arrangements for transferring patients to other settings
  • advocate for escalation of care for deteriorating patients when needed