Standardizing communication and education processes when teams handoff patients to other teams could help improve outcomes.
Teaching hospitals’ processes for end-of-rotation handoff vary greatly.
Excerpt: “Care transitions — when one doctor or medical team takes over for another — have increasingly been recognized as a vital but challenging aspect of medical care. Typically, at the end of a two- or four-week block, a team of doctors — interns, residents and attending physicians — passes responsibility for a group of patients to a new team.”
“Research has shown that handoffs between shifts can be dangerous, and efforts to standardize these transitions have led to measurable improvements in patient safety. But less attention has been paid to what happens when an entire team leaves and a new team comes on at teaching hospitals, which train new doctors and provide about half of all hospital care.”
“One important step would be standardizing the handoff process, which has been shown to improve end-of-shift transitions but hasn’t rigorously been tried for end-of-rotation transitions. Hospital protocols for transition and formal education on end-of-rotation handoffs vary widely. A resident might communicate important history and tasks verbally, in person, in writing — or not at all. Hospitals should ensure that residents have dedicated time and standard templates for communicating about consultant recommendations, discharge planning and important patient conversations. Some programs are experimenting with doing handoffs at the bedside or even having a resident from the prior team participate in rounds with the new team on its first day.
“Another change might involve staggering when residents rotate off service so at least one team member has a longer perspective about the unit’s patients. And greater patient and family involvement will also be important.
“‘Most patients aren’t even aware these transitions are happening,’ Denson [the study’s lead author] said. ‘We need to do a better job of letting them know and engaging family members who can ask questions during high-risk periods.’
“Care transitions are an unfortunate but inevitable part of providing medical care. Experience and data suggest that patients are particularly vulnerable during these periods but also that there’s much more we can do to minimize harm and maximize safety.”
Source: Washington Post
WBB Take: Care transitions are a major source of medical mistakes, contributing significantly to increased morbidity and mortality, as well as increased financial cost and litigation. A core focus of quality improvement approaches such as Lean Six Sigma is the reduction of unnecessary variation. Variation in handoff policies leads to lower overall quality, since not all variants will be equally safe and efficient, and standardization on the better variants will lead to increased overall safety and quality. Likewise, a large number of variants means that new hires, including recently graduated clinicians, will have to learn alternative processes for handover than what they previously used. As a result, initial productivity will be lower for these clinicians, and the risk of medical error significantly higher. Team rotation magnifies these effects, and should be seen as an urgent target for process improvement to reduce risks of medical errors, missed opportunities, and rework costs. Seen in this context, the workflow involving patient handoff is a high-value target for process improvement interventions, and a place in the healthcare value chain at which significant improvement can be achieved at relatively low cost.