A significant source of medical errors occurs when there is miscommunication between providers during patient handoffs in hospitals. A recent study published in The Journal of the American Medical Association reveals that medical errors in hospitals can be greatly reduced by adopting standardized communication during patient handoffs.
The study authors, physicians at Boston Children’s Hospital, created a three-part handoff system that includes standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. The study itself involved 1,255 patient admissions (642 before and 613 after the intervention) and 84 physicians, and took place from 2009 to 2010. The new system included a two-hour communication training session and interactive discussion regarding best practices for verbal and written handoffs. A mnemonic was provided to help clinicians remember and standardize verbal handoffs.
Finally, the handoff process was restructured so that it took place in a private quiet space and was overseen by a chief resident or attending physician (at least once per resident per month). The handoff was changed from an individual handoff to a team process, integrating interns and senior residents. In one hospital unit, a computerized handoff tool was integrated into the electronic medical record.
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The study authors then compared the rate of errors between the group of admissions before the implementation of the new system, and a similarly sized group of admissions afterward.
Medical errors decreased from 33.8 to 18.3 per 100 admissions. Preventable adverse events decreased from 3.3 to 1.5 per 100 admissions. In addition, there were fewer omissions of important handoff elements on printed documents.
Additionally, results showed that doctors actually spent a greater percentage of time in a 24-hour period at a patient’s beside after the new system (10.6% vs. 8.3% before the system was implemented). The time it took to conduct a verbal handoff did not change, according to the investigators, but handoffs were more likely to take place in a quiet and private location after the new system. There was no adverse impact on resident workflow.
“Given the increasing frequency of handoffs in hospitals following resident work-hour reductions and the high frequency with which miscommunications lead to serious medical errors,” the authors concluded, “disseminating high-quality handoff improvement programs has the potential for benefit. Further work to improve and standardize handoffs across specialties and settings may lead to improvement in the safety of patients in teaching hospitals nationwide.”
