International handovers in elite sport

Accurate clinical records are key to patient safety and protect patients and clinicians in sports medicine and science. In professional football for instance, there are currently 211 men’s5 and 159 women’s6 FIFA registered international football teams. Squads generally consist of 23 players, resulting in up to 8487 players being available for ‘call up’ to international fixtures. Medical and sports science resources vary widely across clubs, sports, sexes, countries, age groups and Para sports, and information available for handover will vary accordingly, creating challenges to meet consistent standards.

Sharing data

Many professional sports clubs monitor and handle a vast amount of medical and sports science data to manage injury/illness, load, training regimes, injury prevention, playing availability and support optimal performance. Sources of data include traditional medical records, rate of perceived exertion, global position systems, heart rate monitoring, and various adapted patient reported outcome measures and sleep metrics. Where resources permit, these types of data are often continuously monitored, regularly reviewed, and discussed by medical and sports science multidisciplinary teams within professional sports clubs.

These data are important to medical staff of national teams to maintain continuity of care and avoid significant changes which can place athletes at risk of injury and sub-optimal performance. By providing these data as part of an athlete’s medical handover, medical staff of the club and national teams will be better able to serve the needs of the athlete,7 both in performance and their safety/well-being. Some national teams request completion of medical ‘fitness for duty’ forms which may provide some limited information but are often not a complete medical handover that provides all necessary information to transfer care from one team to another. Since the physical demands of international and club sport can differ, thoughtful training modifications and transitions are needed to mitigate injury risk.

The athlete’s role in handovers

Athletes are a key partner in their own medical care and must make autonomous, informed decisions on all associated risks to performance and injury which can also affect their quality of life, physical and mental health, and careers. Athletes compete in different teams and might move between clubs and national teams several times per season. A prerequisite to medical handovers is the consent of the athlete to share their medical information; consent (verbal and/or written) should be documented.

Medical and performance data are sensitive. All stakeholders have a responsibility to ensure this information is readily and securely available for the benefit of the athlete. There are several ways to ensure safe handling of data (eg, complying with General Data Protection Regulation (GDPR) in the European Union). One method is for athletes to be given their ‘own’ handover. Alternatively, electronic health and performance (science) records can be consensually shared between club and national medical teams.

Recommendations for athlete-centred handovers

Language and medical culture may differ between clinicians involved in medical handovers for international athletes, creating additional challenges for a sufficient and accurate transfer of information to safeguard the well-being of the athlete for both club and country. Table 1 is a checklist of pre, and post camp written medical and sports science handover information which may assist a safe and comprehensive handover, ensure medicolegal accountability, but most importantly protect the welfare and interests of international athletes. Club and country medical and sports science counterparts should agree on their preferred communication formats and personnel. Medical records, performance data, results and reports should always be shared in written format. Urgent medical updates on injuries or illness during a camp or competition should be actioned as soon as possible and in a suitable format such as by phone call, messaging, or confidential email, with written complete medical records to follow, when fully collated.

Impact of COVID-19 on handovers

COVID-19 continues to impact international sport. Many federations, sports and countries have published, and regularly update their own COVID-19 guidelines. Medical teams should ensure compliance with prevention and testing measures. The safe handling, reporting and sharing of all COVID-19 related data including recent testing results, any potential COVID-19 exposures, prior infections, and subsequent cardiac investigations is paramount. All stakeholders have a responsibility, including national and international sports federations and their governing boards, to agree and implement appropriate policies and procedures to support and protect both medical teams and athletes.