Taking the guesswork out of patient handoffs
• Pediatric and adult hospitalist at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati Medical Center.
• Associate program director for the Internal Medicine-Pediatric Residency program at the University of Cincinnati College of Medicine.
• I-PASS study’s site investigator at the Cincinnati Children’s Hospital.
Hot question: Will standardized handoffs improve patient outcomes?
Question: Everyone is talking about handoffs right now. What are the biggest mistakes that hospitalists make in this area?
Dr. O’Toole: I think the biggest mistakes hospitalists make during handoffs are not using a standard structure and not embracing communication best practices of high-performing teams.
Within a hospitalist group each individual may handoff their patients, in both written and verbal fashion, slightly differently. Having consistency within a group is critical. Embracing good communication techniques, such as the TeamSTEPPS techniques we used during I-PASS, is also essential.
I’m also a strong believer that you need to have a verbal interaction and a written component to the handoff. It’s not enough to send a colleague a well-composed written handoff document via a secure e-mail. You need to have a verbal communication so that you can emphasize important patient information with verbal cues and so that the receiver can have an opportunity to ask questions. This verbal communication does not have to be lengthy. I am well aware that time is a scarce commodity for all practicing hospitalists. However, a concise, well-composed verbal interaction is an essential element to the safe handoff of patients.
Question: Fast forward 5 years. Do you think that most hospitalist programs will be using some type of standardized handoff tool?
Dr. O’Toole: Yes, I hope this will be the case. However, for this to occur we need to have solid research and outcomes surrounding standardized handoff programs and their impact on medical errors. It’s an area that has been lacking. As a result, a lot of institutions and hospitalist groups have been apprehensive about saying, ‘This is the best way to execute a handoff,’ since they don’t have solid data to show that a handoff process or program improves patient care and safety outcomes. That’s one of the benefits of the work we’ve been doing with the I-PASS project. We are evaluating the effects of a standardized handoff bundle on medical errors, verbal and written miscommunications, and satisfaction and work flow among residents.
A study with the scale and scope of the I-PASS study has never been attempted before and will hopefully provide the evidence hospitalist programs, residency programs, and institutions need to get full support to implement a comprehensive, evidence-based handoff program.
Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to mschneider@frontlinemedcom.com.
