HealthFebruary 07, 2020

Improving communication during patient transfers

By: Heidi Moawad, MD

As a physician, you work hard to deliver the best care when diagnosing and treating your patients. But the handoff process during patient transfers is among the most important aspects of patient management. Research in Pediatric Quality & Safety (PQS) finds that, of the two-thirds of sentinel events tied to communication errors in the United States, over half involve handoff failures.

Despite its importance, patient handoff communication is far from perfect. While the PQS paper points out that standardizing handoffs between clinicians improves patient safety, a study published in the Journal of the American Association of Nurse Practitioners reports that there is a lack of such standardization when patients go from the emergency ward to the inpatient setting. But patient handoff isn’t just an inpatient issue. Ongoing outpatient care often requires coordination between clinicians as well.

If you recognize the key points when care is handed off between you and other clinicians, you can develop and follow best practices when it comes to signing out your patients and picking up care from other doctors.

The troublesome points of transition

There are a number of recognized transition points in patient care. The gaps in communication—and the resulting errors—tend to occur when patient care shifts between different types of clinicians, such as between a surgical specialist and a medical specialist, or between a physician and an advanced practice provider. This is especially problematic if the transitions are not routine or frequent enough for a built-in protocol to have developed.

For example, there can be a breach in communication when your patients go from the emergency room to the intensive care unit. Or details can fall through the cracks when your patients move between an inpatient stay and rehabilitative care or a nursing home. And when a patient who has a chronic illness transitions their disease management from one healthcare system to another (such as when health insurance changes), nuances in the diagnostic approach may not be adequately conveyed between clinicians.

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Challenges to effective communication

Physicians sign out to other physicians, nurses sign out to other nurses and all clinical care providers interact with each other, often relying on peers to accurately communicate a patient’s medical status and plan.

There are many reasons that patient transitions may not go smoothly. A study published in the Journal of Patient Safety points to clinician workload and organizational structures as the leading limitations of implementing effective handoffs. This means that playing the blame game and pointing fingers when patient information gets lost in the shuffle is not likely to be an accurate or successful strategy. Acknowledgment of system-wide challenges and directing everyone’s focus toward comprehensive problem-solving are far more likely to be effective.

Digital record keeping: A double-edged sword

Digital record keeping can be time-consuming. And, as an article in STAT points out, electronic medical records (EMR) were built for billing rather than for describing patient stories. While you may wish to completely change your EMR, there are immediate steps you can take to alleviate EMR-induced problem spots in patient transfers.

Start by pinpointing the shortcomings and making sure that clinicians you share patients with also know that your system does not recognize certain important aspects of patient management. And as a team, you may need to work together to find an alternative way to communicate these important patient management issues.

Successful patient handoffs

The keys to safe and effective patient handoffs lie in timing, consistency and mutual understanding between the clinician who is handing off care and the clinician who is taking over care.

When it comes to timing, an agreed-upon point for clinician-to-clinician communication is essential. When patient care is transferred from one doctor to another, clinicians might not be ready for the transfer of information at the same time. Deciding on a schedule for handoff communication is valuable, even if it takes a few negotiations to finally settle on the right time.

Consistency is a key component as well. Computers, Informatics, Nursing describes a project using the IPASS handoff form to reduce adverse events. When everyone in the hospital uses a consistent method of handoff, problems are less likely to occur. And when use of a standardized method reaches even beyond just one hospital system, it can be even more beneficial.

Last of all, confirming that everyone is on the same page helps identify small issues that could have been miscommunicated before any problems have the chance to develop.

Heidi Moawad, MD

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