Inpatient Handoffs Between Attending Physicians

Purpose:
The purpose of this policy is to ensure that all communication of patient handoffs between
attending physicians is standardized, contains accurate information about a patients care, and
ensures a seamless transition in management of the patient.
A patient handoff is defined as a transfer of care between one caregiver and another (e.g. each
evening, before a weekend, at the end of a rotation or between services).
Scope:
This policy applies to all inpatient handoffs from Attending to Attending physicians.
Attending to Attending handoff must occur in the following situations
Change of provider shift and/or coverage on the inpatient service
Change in coverage for inpatients and those scheduled for discharge, while out of town
or when unavailable
Attending to Attending handoffs must occur in the following situations unless deemed clinically
unnecessary by the sending attending:
Admissions from ED to Inpatient services
Admission from BWH MD office to Inpatient service of another Attending
For all transfers between services for example:
o Transfers from ICU to floor with change of Attending
o Transfers from floor to ICU with change of Attending
o Transfers from OR/PACU and ICU/floor with change in Attending
Discharges to another care facility
Procedure:
Direct communication by phone call from Attending to Attending physician is expected for ALL
acute issues as deemed clinically necessary (by either the sending or receiving physician) or per
existing department policy.
For all other situations, email is appropriate with contact information such as cell phone or pager
number.
When a handoff occurs, it must occur in such a manner to allow for the ability to ask and answer
questions. Critical elements in the handoff include but are not limited to the following:
Patient name and medical record number or date of birth
Diagnosis
History, including date and type of procedure and any operative findings as it applies
Anticipated problems and active issues (including expected date of discharge when
necessary, family dynamic, end of life discussion, etc.)
Current vital sign abnormalities
Code status
Covering team

Notes:

The Attending physician of record must be notified of any patient admissions or transfer
(Each service is responsible for establishing a mechanism to do this)
For direct admissions from the office or another facility, email, LMR Expect Note or a
phone call are all appropriate
Attending to Attending handoff communication for discharges can be done with verbal,
email, or letter communication, and should be performed if there are specific issues that
need follow up after discharge. This communication is in addition to the discharge
summary/orders entered by the house staff or other qualified provider.
Ongoing Monitoring:
It will be the responsibility of each Chief to disseminate this policy and respond appropriately to
breaches in compliance.
Approvals: MSEC 2/08, CIC 12/08
Sponsor: Anthony Whittemore, MD