communication and handoffs cathryn caton, md, ms
TRANSCRIPT
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Communication and Handoffs
Cathryn Caton, MD, MS
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Goals and Objectives
Define clinical handoffs
Demonstrate the importance of effective handoffs
Understand key components of an effective standardized handoff
Discuss the handoff environment and communication techniques
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Clinical handoff
A clinical handoff is the temporary transfer of care and responsibility from the primary physician to the covering physician Verbal Written
Increased handoffs with reduced work hours
Many training programs do not have standardized handoff training programs
75 handoffs/month /team here at MUSC
Improving handoffs is a national patient safety goal
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Handoffs and patient safety
Associated with adverse clinical outcomes
Sentinel events commonly results from communication breakdown – 65 % of the time
92% of communication errors occur during verbal communication between 1 transmitter and 1 receiver
Errors surround omission of content or lack of direct discussion
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Fellow
Resident/Intern
Student
Attending Attending Attending
Fellow Fellow
Resident/Intern Resident/Intern
Student Student
Primary Team Consult TeamTransferring
team
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Ideal handoff components
Face to face interaction for verbal communication
Updated written or computerized information (use actual dates)
Clarity about the patient’s current condition, including severity of illness
Anticipating changes in patient condition with specific interventions
Minimal interruptions
Structured format (time, place)
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Summary of Themes from “White Papers”
Need for training
Ensure adequate time for handoff
Reduce interruptions
Keep information updated in template or technology solution
Facilitate interactive questioning
Focus on ill patients
Delineate actions to be taken
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Verbal Signout
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Written sign out
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Key Messages
Good handoffs may reduce sentinel events / improve patient safetyUse standardized formats InteractiveFocuses on ill patientsProvides anticipatory guidance
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References
Joint Commission Sentinel Event Database
Greenberg CC. J Am Coll Surg 2007; 204;533
Arora V. Qual Saf Health Care 2005; 14:401
Arora VM. J Hosp Med 2009; 4:433