Plug Building Security Risks

Hundreds of service handoffs take place everyday when hospitalized patients are transferred between caregivers and units. Ideally, handoff transfer of patient care responsibilities occurs without a break in activities. A successful handoff avoids unwarranted changes in patient care goals, decisions, or plans, including dropping or reworking activities that others were told would be done by the previous caregiver. An increasing number of studies show that traditional methods of gathering patient data, organizing it, and communicating it among caregivers may not support high quality patient care. Practitioners must move beyond long-standing practices of information transfer (based on a one-way monologue) and toward a more effective system of information exchange (based on two-way dialogue).

Improving information exchange during service handoffs starts with clarifying the intent. What is considered a handoff and what are caregivers trying to achieve during these handoffs? Handoffs don’t only occur at shift change or at transition points (admission, transfer between units, discharge). During a patient’s day, there may be multiple patient handoffs – junior resident to senior resident, physician to nursing staff, surgery team to recover room staff, nurse to nurse handoffs. Common examples of potentially critical handoffs are shift changes for nursing staff and residents and transfer of patient care responsibilities from one physician to another or from one medical team to another, such as after a patient has had surgery and is transported to the post-anesthesia recovery unit. Even seemingly routine handoffs, such as transport of an inpatient to the nuclear imaging department can be problematic if there is poor communication among caregivers. For instance, in one hospital an MRI technician described a situation in which she had particularly difficult time calming a patient during a test – only to find out later that the man was deaf. This vital information was never relayed to the technician when the patient was transported from the inpatient unit.

Don’t overlook handoff situations that involve other facilities or post-discharge caregivers, such as when patients are transferred to another hospital or discharged home for home care services. The transfer of inpatient care by a hospitalist to outpatient care by the patient’s primary physician is another example of a potentially critical handoff.

Ask caregivers involved in each type of handoff to describe what is considered safe and effective transfer of information. Use the questions below as a starting point in this discussion.
* Who is primarily responsible for ensuring satisfactory information exchange?
* What key communication steps need to be followed?
* What minimal information needs to be communicated?
* How should information be exchanged?
* Who should be involved in this exchange?

It is essential that people work together as a team to identify the minimal set of information that needs to be imparted during the handoff and how best to accomplish the communication. With so many individuals involved in the care of patients, it is important for everyone to agree on minimal standards for information exchange. The communication mechanism may vary from unit to unit or situation to situation, however the same essential information should be communicated during a handoff. The specific information will vary according to the situation.

Whatever process changes are made to improve exchange of information during patient handoffs, caregiver training in communication techniques is also important. Safe and effective handoff communications depend on the ability of caregivers to prioritize relevant information and transfer insights effectively. Practitioners and staff often have had no formal training in handoff communication; it is often just learned on the job. No matter how efficient the handoff process becomes, the proper information exchange won’t take place if people don’t have the right communication skills.

To Learn More: Patrice L. Spath is available for in-house presentations on this and other health care performance improvement topics. For further details, visit Brown-Spath & Associates on the web at: http://www.brownspath.com or write to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116.

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