In the hospital setting, patient care continues around the clock. Care providers come and go over the course of a day and patients are transitioned from one to another, or perhaps from one unit or department to another. Across this continuum of care, there are doctors, nurses, therapists, aides and others partaking in care requiring consistency and continuity to maintain safety and quality.
Too often, communication between one practitioner and the next does not occur or is incompletely or confusingly transmitted. This failure creates potentially dangerous errors and care that may not be timely. Harvard's Risk Medical Foundation says clinical communication failures in U.S. facilities are attributed to approximately 30% of medical malpractice claims. In the last five years, this problem led to over 1,700 fatalities and over $1.7 billion in malpractice-related expenses.
What is a Hand-Off?
A hand-off refers to the process of transferring and accepting responsibility for a patient between providers. This process occurs in real time where key patient data is communicated in efforts to maintain consistent and safe care. Communication failures in these instances are most common when conducted between those of different disciplines. The problem recently was addressed by The Joint Commission when they issued a Sentinel Event Alert. They emphasized that leadership must make efforts to implement and sustain proper hand-offs as part of their comprehensive plans.
Properly Communicating Key Patient Information
The Joint Commission's considerations regarding patient transfers were as follows:
- Decide what key information must be communicated
- Implement a protocol of ways and tools used to communicate
- Consider worksheets, templates, and ways to remind caregivers
- Consider options including phone, video or other electronic means of conducting communication
- If the key patient data comes from multiple sources it may need to be combined--and then communicated
- The minimum required data includes:
- The contact information of the sender
- Patient allergies
- Status of coding
- Medication information
- Lab testing data
- Vital signs (dated)
- Assessment of condition and severity
- Plan of care summary
Effect of Interruptions
Physicians and nurses may encounter interruptions multiple times per hour. Roughly 43% of these occurrences negatively impact patient care in some manner. Communication regarding patient transfers may be best conducted in person at locations that are free from interruption. When a significant transition is occurring, it may be appropriate to include team members and/or the patient and their family.
Assistance of Technology
Plenty of technology products exist in the market to assist with facilitating such processes. Some include electronic health record systems, apps, network portals, etc. A key is establishing a standard that communicates all relevant data, yet is geared toward efficiency. Smartphones offer tremendous options for communicating, which obviously would need to meet current security standards. One fundamental reason that face-to-face hand-offs do not occur is often the difficulty in locating one another. If communications are streamlined, ideally using existing electronic systems to some extent, patients will receive care from a practitioner who is well informed.