Standardized procedures

In 2005, the Joint Commission approved the 2006 National Patient Safety Goals, a set of 15 safety objectives that hospitals were required to meet by this past January.

Because communication breakdowns as a result of handoffs present such significant error potential, Goal 2 of these objectives requires hospitals to improve the effectiveness of communication among caregivers, and includes specific measures to target some of the most risk-fraught areas of communication.

For example, when a lab is providing test results or taking an order for a test, the person receiving the information is now required to record it and read it back. Also, hospitals are required to stop using a list of confusing abbreviations, acronyms, symbols and dose designations.

When it comes to transfers of care, Goal 2 requires hospitals to "[i]mplement a standardized approach to ‘handoff’communications, including the opportunity to ask and respond to questions." Boston health care lawyer Alan Rindler said such an approach will ultimately help cut down on errors, particularly those stemming from a failure to read a lab report or X-ray.

"Unfortunately there have been too many instances where for [some] reason a report was never read or never got into the patient’s record," said Rindler, a partner with Rindler Morgan. JCAHO has not provided a specific formula that hospitals must follow to be in compliance with the standardization requirement, except requiring that any process include the opportunity to ask and answer questions at the transfer point. But according to the commentary that accompanies the goals, hospitals must also "define, communicate to staff, and implement a process in which information about patient care is communicated in a consistent manner."

Under the rules, a standardized approach should identify: specific situations it applies to, who must be involved in the communication, what specific information needs to be communicated (critical patient information, anticipated changes in condition or treatment and what to watch for) and what print or electronic information should be available. "We expect hospitals to have done this and have it in place," said Croteau. "If they’re not in compliance, they have an opportunity to make the necessary chances. They’re generally given a couple of opportunities. But if they continue not to comply with this requirement, they will lose their accreditation."

Next: Better Communication