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Flubbed handoffs of patients between doctors leads to errors, MGH survey finds

E-mail|Link|Comments (5) Posted by Elizabeth Cooney September 23, 2008 03:23 PM

Patients routinely have responsibility for their care passed from one physician to another as doctors' shifts end or as patients move from one department or hospital to another. When schedules of resident physicians were limited to 80 hours a week in 2003, the expected increase in handoffs -- already a cause for concern because of the chance for miscommunication -- attracted more attention.

A 2006 survey of resident physicians at Massachusetts General Hospital found that handoffs commonly lead to patient harm, according to an article in The Joint Commission Journal on Quality and Patient Safety. More than half of the 161 medical or surgical residents who responded to the anonymous survey said they recalled at least one occasion in their last month-long rotation when a patient suffered from flawed handoffs. About one in nine said the harm that resulted was significant.

"Problematic handoffs may be as significant a source of serious patient harm as are medication-related events," Dr. Barry T. Kitch of the MGH Institute for Health Policy said in a statement.

Problematic handoffs were defined as having inaccurate, incomplete, or missing information, the authors say. The survey took place before the hospital had begun using its formal electronic sign-out tool. Almost all the residents said the handoffs were face-to-face, almost half said they rarely occurred in a quiet setting, and more than a third said they were interrupted at least once.

If the patient was coming from the emergency department or from another hospital, problematic handoffs were more likely, the residents said.

The authors recommend compiling better information for handoffs and conducting them in a quiet, uninterrupted setting that allows questions to be asked.

"We believe that a useful step ... would be to change the culture from one of viewing handoff-related harm as inevitable to one in which error minimization is seen as mandatory," the authors write.

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5 comments so far...

Maybe, this wouldn't be a problem if the residents were not scheduled to use up their entire 80 hour limit. Think about it: if hospitals cared about patients at all, they would limit residents (i.e., cheap labor) to about 70-75 hours per week, which would leave 5-10 extra hours a week to prevent rushed handoffs. Under this proposal, residents could stay a few more minutes (up to an hour) to ensure handoffs are not rushed. Or, hospitals could make it such that all residents use their last hour of any particular shift to ensure the handoffs are not rushed.

Posted by joe September 23, 08 04:16 PM

Errors would also be reduced greatly if there were more English speaking doctors and staff. Most are very hard to understand.

Posted by Mary Jane Power September 23, 08 05:03 PM

Perhaps Joe,
But another way to look at it would be if residents stayed longer there would be less handoffs overall.
While no is arguing to go back to the days of >100 hours per week, it must be said this issue is exactly what many worried about when these rules were first implemented.

Posted by doctorrick September 23, 08 05:05 PM

"The survey took place before the hospital had begun using its formal electronic sign-out tool."

Better resident record keeping, and mandatory review by the incoming physician is the key to proper handoff. Retaining the verbal communication is key, as there always are "Oh, and don't forget to" things which might miss the records.

Posted by bill September 23, 08 05:13 PM

The frenetic pace in hospitals isn't going to change any time soon. The suggestions for solving problematic handoffs that cause medical errors are good, but are they reasonable? What needs to happen is the introduction of a third party between physician and patient, a patient's family member or good friend to act as a communication facilitator and watch dog in effort to prevent medical errors as a result of problematic handoffs. My book, Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive, illustrates how to be such a watchdog and facilitator for a hospitalized loved one.

Posted by Martine Ehrenclou September 24, 08 05:29 PM

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Elizabeth Cooney is a former health reporter for the Worcester Telegram & Gazette, where she also was a business reporter and an editor. Earlier in her career, she edited medical books and journals at Little, Brown, and worked for Boston magazine.