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Health Assessment · Chapter 3

The Handoff Room

A handoff is the transfer of responsibility, not a recitation of the chart — and it is the highest-risk moment in a hospital stay because responsibility can quietly land on nobody. Build an I-PASS report line by line, decide what gets verified at the bedside and what is said privately, then finish a transfer or a discharge.

Build the I-PASS report

0645, shift change. Choose the best line for each element. Illness severity is one word and it goes first.
Bed 12 — Ellen Marks, 68. Full code. Post-op day 1, right hip ORIF. At 0200 she became short of breath and desaturated to 88 percent on 2 litres; now 93 percent on 4 litres. CT pulmonary angiogram negative for pulmonary embolism; the team believes atelectasis. Heart rate 96, blood pressure 112/68, respirations 22, afebrile. Incentive spirometer at the bedside. CBC pending at noon. Physical therapy expected at 1000. Apixaban held pre-op, not yet restarted.

Bedside shift report

Both nurses enter together, the off-going nurse introduces the on-coming nurse, and you ask the patient’s permission before anyone else hears report. For each item: do you verify it together in the room, or say it privately outside?

Transitions of care

Choose the transition, then select everything that must be included. Anything you leave out lands on nobody.

Your handoff, as spoken

Nothing said yet.

Why handoffs fail

  • Information overload — a fifteen-minute recitation of the whole chart with the critical item buried in minute eleven.
  • Omission of pending items — a culture that has not resulted, a scan that has not been read.
  • Interruptions and distraction — the receiver needs protected, uninterrupted time.
  • No chance to ask questions, and no explicit transfer: end with “You have her.”
  • No synthesis. A handoff where only one person talked is a monologue. If you are receiving report and you did not repeat anything back, you have not accepted the patient yet.