Reducing Errors, Liability in Patient Handoffs

By Eric Berkman

Handoffs of patients from one hospital unit to another are rife with serious medical errors – and hospitals in Massachusetts and beyond are developing new strategies to avoid the med-mal claims and litigation that can result. Last year, the Joint Commission issued rules that required hospitals to standardize their communication processes to reduce the risk of errors related to patient transfers, known as “handoffs,” by January 2006 – or risk losing their accreditation.

According to the Joint Commission, communication problems in handoffs play a significant role in the majority of serious injuries or death from medical errors in a hospital setting. “We’ve seen that approximately 70 percent of all serious adverse events are related to breakdowns in communication, typically at the point of handoff,” said Dr. Richard Croteau, executive director for patient safety initiatives for the commission. Cambridge attorney Martin Foster represented a hospital in a med-mal case where a staffer in one unit misunderstood the patient’s medication dose and repeated the error verbally to the staffer taking over his care. Instead of getting the 30 grams of cardiac medicine he should have received, he got 300 – and died before the error was caught. That case settled without going to suit, Foster said. To avoid situations like that one and comply with the Joint Commission rules, hospitals have been sharpening various strategies to improve their communication processes, including:

• Improving the efficiency and comprehensiveness of handoff communications;
• Ensuring that important patient information is exchanged in both written and verbal form;
• Creating more of a “team” mentality to encourage freer exchange of observations and opinions; and
• Redesigning workflow processes to ensure quick transfer of critical information.

While these measures should reduce handoff-related medical errors, lawyers don’t expect a major drop-off in the number of malpractice cases filed. “I don’t think [the directive] will impact the overall medical-malpractice climate,” said Dennis Anti, a med-mal defense lawyer in Springfield. “Plaintiffs’ lawyers are creative and will look to different areas to find potential liability.” Nonetheless, “hospitals should absolutely be doing all they can to have smooth handoff procedures,” said Anti, who practices with Morrison Mahoney. “It makes good sense for the patient and for the hospital’s own potential liability.”

Next: Standardized Procedures