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Incomplete Handoffs Hinder Patient Safety, Workflow


 

Nearly one in five hospitalists admitted uncertainty about transitional patient-care plans after service change, according to a report to be published in this month’s Journal of Hospital Medicine.

The review, a single-institution study conducted at the University of Chicago, found 18% of respondents acknowledged uncertainty, 13% reported incomplete handoffs, and 16% attributed at least one “near miss” to incomplete communication. The study suggests that “investments in improving service change could not only improve patient safety, but they could improve hospitalists’ daily workflow,” says senior author Vineet Arora, MD, MAPP, an academic hospitalist and associate director of Internal Medicine Residency at the University of Chicago.

Keiki Hinami, MD, MS, instructor of medicine in the Division of Hospital Medicine at the Northwestern University Feinberg School of Medicine, says a unique facet of the report, titled “Understanding Communication During Hospitalist Service Changes: A Mixed Methods Study,” was the understanding by physicians that successful handoffs often involve more than a brief conversation or a pass-through of documentation.

“The outgoing doctor would come back to the incoming doctor and ask for updates, or they would solicit the incoming doctor for more information if they needed it,” says Dr. Hinami, who was one of the study’s authors while employed as a clinical associate by University of Chicago. “The participants of our study naturally adopted a strategy acknowledging that one conversation is not usually sufficient.”

The study measured 60 service changes among 17 hospitalists on a non-teaching service from May to December 2007. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about care plans (71% incomplete vs. 10% complete, P<0.01), discovery of missing information (71% vs. 24%, P=0.01), and near misses/adverse events (57% vs. 10%, P<0.01).

Dr. Arora says work is under way to develop educational programs and evaluation tools to train hospitalists and others to improve service change handoffs.

“How do you teach people to communicate only pertinent information?” Dr. Hinami says. “That’s really a difficult challenge. Even though handoffs are something we do every day, most people have never had any formal training in communicating that.”

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