Better Communication

Richard Frankel, a professor at Indiana University School of Medicine who authored a study on handoff-related medical errors, said the most important thing hospitals can do to reduce the risk of error is formalize their communication processes to ensure completeness and accuracy, both orally and in written form. “I’ve seen handoffs done on the back of a napkin and I’ve heard them done by telephone,” he says. “This informality is often a root cause of the problem.”

To address this issue, Massachusetts General Hospital in Boston is implementing an electronic solution – a “handoff” application that brings up all of a patient’s vital information (name, age, reason for admission, medication, etc.) on a computer screen at the point of transfer. The system enables the transferring caregiver to add any additional information, such as recent events and observations, which might be important for the receiving caregiver to know. Both the transferring and receiving caregivers will view the patient’s record at the time of transfer. The application also asks for confirmation that any clarifying questions were answered. Ultimately, MGH hopes to issue handheld computers to professional staff to make this process more manageable on the fly. MGH is implementing another program to teach proper handoff protocol via simulation.

We’ve enlisted a national safety expert to teach the chief residents this program and they in turn will do the simulations with their staff,” said Dr. Andrew Karson, associate director of MGH’s Decision Support and Quality Management Unit. Hospitals are also addressing communication issues by examining their work processes.

For example, the Beth Israel Deaconess Medical Center in Boston – which has a high volume of handoffs from its emergency department to various inpatient units – has deployed dedicated telephones in each inpatient unit for transfers from the ER. There’s also a designated nurse to answer the phone each time it rings. “This ensures that there’s no phone tag,” said Kathy Murray, Beth Israel’s director of process improvement in the Department of Healthcare Quality. “When the nurse in the emergency department makes the call, he or she knows that the phone will be answered.”

Whenever a patient is moved from an inpatient floor to a critical care floor, he or she travels with a nurse, who provides both written and verbal information to the caregiver at the receiving point. Beth Israel has also been implementing templates for information exchange to make sure all of the essential information is transmitted accurately. “When I’m passing off a patient, I won’t just say whatever comes to the top of my head when I call,” said Dr. Julius Yang, a hospitalist at BI. “The [receiving caregiver] will be expecting certain types of information each time and I’ll be prepared to give it.”

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