The Physicians Corner

Henry Tulgan, MD, FACP

When physicians think about patient handoffs, often, the first thing that comes to mind is is a nursing shift change. However, the extent of handoffs during hospitalization is far greater than what seems obvious at first. For this reason, the Joint Commission has included safe patient handoffs in its 2008 Hospital National Patient Safety Goals. The Joint Commission requires hospitals to implement a standardized approach to handoffs that includes the opportunity for patients involved in a handoff to ask questions, have information verified and request the use of such mechanisms as repeat back and read back. The person who receives information about the patient must also have full access to all historical data about his or her care?. These safeguards ensure accurate communication about current and anticipated care, condition—particularly if it may worsen-- and all treatments including medication reconciliation.

The Accreditation Council on Graduate Medical Education (ACGME) has recognized the importance of communication as one of its six Core Competencies since 2003, and now many other organizations such as The Accreditation Council for Continuing Medical Education (ACCME), The American Board of Medical Specialties (ABMS) and The Institute of Medicine (IOM) have recognized and emphasized its importance as well.

We, as physicians, may transfer patients to another physician or to a covering one, and accuracy in these handoffs is mandatory—(remember resident sign out rounds?) We interact daily with our laboratory and radiology colleagues where accurate communication must take place.

Physician-to-physician handoffs may happen in many settings,including: directly on patient floors; between Emergency Departments and hospital floors; and within the operating suite where anesthesiologists may be responsible for several cases at a time. In teaching hospitals, if residents are members of the surgical team, they may have to be replaced by others to comply with the work rule regulations of the ACGME. Sometimes entire teams may even need to switch during very long and complicated surgeries and careful transmission of a multitude of information is essential.

As members of the health care team, we must communicate accurately with nurses and other allied health care personnel both in hospital settings and outpatient ones such as nursing homes, home care agencies and others.

Recognizing the many handoffs that are continually occurring, abiding by our hospitals standards and setting our own standards will dramatically reduce the chance of errorand thereby protect us from possible litigation from potential errors. It is a wise precaution to take.

Risk Management Strategies

Review your organization or office’s “handoff” communication plan, which should include procedures to:

• Communicate information regarding up-to-date patient care, treatment, services, condition and any recent or anticipated changes when you are “handing-off.”
• Verify the received information, including repeat-back or read-back as appropriate.
• Give the receiver of the “handoff” information the time and opportunity to review relevant patient historical data, which may include previous care, treatment and services, as well as the opportunity to ask and respond to questions.
• Ensure that important patient information is exchanged in both written and verbal form.
• Monitor “handoff” communication processes adopted by your office or organization to ensure they are followed on a consistent basis.
  

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