Communication and handoffs
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Communication and Handoffs. Cathryn Caton, MD, MS Medical University of South Carolina January 22, 2013. Goals and Objectives. Define clinical handoffs Demonstrate the importance of effective handoffs Understand key components of an effective standardized handoff

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Communication and Handoffs

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Communication and handoffs

Communication and Handoffs

Cathryn Caton, MD, MS

Medical University of South Carolina

January 22, 2013


Goals and objectives

Goals and Objectives

  • Define clinical handoffs

  • Demonstrate the importance of effective handoffs

  • Understand key components of an effective standardized handoff

  • Discuss the handoff environment and communication techniques


Clinical handoff

Clinical handoff

  • A clinical handoff is the temporary transfer of care and responsibility from the primary physician to the covering physician

    • Verbal

    • Written

  • Increased handoffs with reduced work hours

  • Many training programs do not have standardized handoff training programs

  • 75 handoffs/month /team here at MUSC

  • Improving handoffs is a national patient safety goal


Handoffs and patient safety

Handoffs and patient safety

  • Associated with adverse clinical outcomes

  • Sentinel events commonly results from communication breakdown – 65 % of the time

  • 92% of communication errors occur during verbal communication between 1 transmitter and 1 receiver

  • Errors surround omission of content or lack of direct discussion


Communication and handoffs

Primary Team

Consult Team

Transferring team

Attending

Attending

Attending

Fellow

Fellow

Fellow

Resident/Intern

Resident/Intern

Resident/Intern

Student

Student

Student


Ideal handoff components

Ideal handoff components

  • Face to face interaction for verbal communication

  • Updated written or computerized information (use actual dates)

  • Clarity about the patient’s current condition, including severity of illness

  • Anticipating changes in patient condition with specific interventions

  • Minimal interruptions

  • Structured format (time, place)


Summary of themes from white papers

Summary of Themes from “White Papers”

  • Need for training

  • Ensure adequate time for handoff

  • Reduce interruptions

  • Keep information updated in template or technology solution

  • Facilitate interactive questioning

  • Focus on ill patients

  • Delineate actions to be taken


Verbal signout

Verbal Signout


Written sign out

Written sign out


Key messages

Key Messages

  • Good handoffs

    • may reduce sentinel events / improve patient safety

    • Use standardized formats

    • Interactive

    • Focuses on ill patients

    • Provides anticipatory guidance


References

References

  • Joint Commission Sentinel Event Database

  • Greenberg CC. J Am CollSurg 2007; 204;533

  • Arora V. QualSaf Health Care 2005; 14:401

  • Arora VM. J Hosp Med 2009; 4:433


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