Communication and Handoffs

Cathryn Caton, MD, MS

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

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

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

Fellow

Resident/Intern

Student

Attending Attending Attending

Fellow Fellow

Resident/Intern Resident/Intern

Student Student

Primary Team Consult TeamTransferring

team

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)

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

Verbal Signout

Written sign out

Key Messages

Good handoffs may reduce sentinel events / improve patient safetyUse standardized formats InteractiveFocuses on ill patientsProvides anticipatory guidance

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