Transfer and Handover

This learning content has been developed in collaboration with the WHO Academy.
Objectives
By the end of this presentation, you will be able to:
• Understand the steps in transferring patients including destination
planning, transport and handover
• Use the SBAR model for patient handover
Essential Skills
This presentation references essential skills required to manage emergency
patients.
Please refer to the WHO/ICRC Basic Emergency Care Manual for detailed
guidance on essential skills.

WHO-ICRC Basic Emergency Care: Approach to the acutely ill and injured
www.who.int/publications-detail/basic-emergency-care-approach-to-the-acutely-ill-and-injured
Transferring Patients
• BEC is a course for providers working in the field, on ambulances and in
health care facilities.
• Patients will require transfer from scene to first facility or between
facilities.

• Steps in transferring patients:

• Destination planning
• Transport
• Handover

©WHO/Laerdal Medical
Destination Planning
• Patient need to be transported from the field but also between health
facilities.

• Patients are also transferred within a facility (e.g., pregnant women from
emergency unit to obstetrics).
Destination Planning
• Ensure level of services at destination facility
match needs of patient (there is an operating
theatre if surgery is needed).

• Ensure expected resources are available

(operating theatre is running, blood for
transfusion).

• Ensure destination can be reached in the

necessary time-frame given patient’s
condition.
Transport
Goal of transport
• Transporting patient
• Caring for patient during transfer

• Both goals CANNOT be done by one person

• Provider with patient at all times during transport
providing continual monitoring
• Another person transports patient

• Anticipate patient’s needs during transport (IV

fluids, medications).

• Ensure family and patient are aware of transfer.

Handover
• Formal handover should be given anytime care is transferred to a new
provider

• Between providers within a facility

• To or from transport providers
• Remotely from a sending facility to receiving facility

• Verbal and written report for each patient

Handover: What is SBAR?

• SBAR is a structured method for communicating critical information

between providers
• SBAR improves communication between providers and safety of patients
• SBAR has 4 steps
• Situation
• Background
• Assessment
• Recommendation ©WHO/Laerdal Medical
Why Use SBAR?
• Reduce the barrier to effective communication across different disciplines
and levels of staff.

• SBAR creates a shared mental model around all patient handovers and
situations and critical exchange of information.

• SBAR is a memory prompt; easy to remember and encourages prior

preparation for communication.

• SBAR reduces the incidence of missed communications.

How Can SBAR Help Me?
• Easy to remember

• Clarifies what information needs communicating quickly

• Points to action
S - Situation
• Identify yourself
• Identify the patient by name, sex, age
• Chief complaint (patient’s initial description of problem)

Goal
• To describe the specific situation including the patient's name, patient
location (and severe vital sign abnormality).
B-Background
• Give the patient's reason for transfer.
• Explain significant medical history.
• Two to four most important and relevant aspects of the case (elements
from history, physical exam, testing results)
• Include any important ABCDE findings/interventions.
• Include vital signs.

©WHO/Laerdal Medical
A-Assessment
• What do you think is wrong with the patient?
• Reason for transfer
• Includes:
• Clinical impressions, concerns

©WHO/Laerdal Medical
R-Recommendations
• Specific things the new provider should prepare for:
• Next steps in treatment plan

• Potential worsening of the patient’s condition (e.g., need for close

airway observation)

• Caution regarding previous therapies (e.g., last adrenaline dose, 3-sided

dressing monitoring)

©WHO/Laerdal Medical
Case 1
A 22 year-old man was riding a motorcycle when he crashed into another
vehicle at high speed. He was thrown from his motorcycle and was not
wearing a helmet.

©WHO/Laerdal Medical

His airway is open; he has normal breath sounds on both sides of his
chest; his pulses are strong and around 90 beats per minute; he is only
responsive to pain and has a femur fracture with bone visible in an open
wound; there are abrasions on his forehead.
You have immobilized his spine, started an IV and splinted the fracture.
You and your colleague have transported him from the scene of injury and
are handing him over to a hospital provider.
Case 1
A 22 year-old man was riding a motorcycle when he crashed into another
vehicle at high speed. He was thrown from his motorcycle and was not
wearing a helmet.
His airway is open; he has normal breath sounds on both sides of his chest;
his pulses are strong and around 90 beats per minute; he is only responsive
to pain and has a femur fracture with bone visible in an open wound; there
are abrasions on his forehead.
You have immobilized his spine, started an IV and splinted the fracture. You
and your colleague have transported him from the scene of injury and are
handing him over to a hospital provider.
Practice SBAR

• Describe the Situation

• Provide Background
• What is your Assessment
• Provide Recommendation

©WHO/Laerdal Medical
Example SBAR
'This is a 22-year-old man who was in a motorcycle crash, was not wearing a
helmet and was thrown from his motorcycle; he is only responsive to pain
and has an open femur fracture but is currently protecting his airway and
has no evidence of shock.

We are concerned for his altered mental status, and open femur fracture, but
are unable to tell if he has a spinal injury. He needs transfer for surgical
management and further neurological assessment. Spinal immobilization
should be maintained, and he should be monitored for worsening bleeding
and mental status changes.'
Conclusion
• Transferring patients is an important and vital part of your job.
• Destination planning is important to ensure adequate resources at the
destination site.
• Transport should have a minimum of 2 people ensuring 1 person is always
with the patient providing continual monitoring.
• Handover is a crucial part in providing appropriate care to the patient
therefore use the SBAR method.
Summary
In this presentation, we have covered:
• Understanding the steps in transferring patients including destination
planning, transport and handover
• Using the SBAR model for patient handover