Joint Commission International Center for Patient Safety - Strategies to Improve Hand-Off Communica...

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Strategies to Improve Hand-Off Communication: Implementing a Process to Resolve Questions

A patient can be cared for by five different units during one hospital staythe operating room, postanesthesia care unit, critical care unit, step-down unit, and medical/surgical unit. Hand-offs help the staff to process information, plan care, and build the health care team. In the health care setting, hand-offs include nursing shift changes, temporary relief or coverage, nursing and physician hand-offs from an emergency department, various transfers of information at the inpatient settings, and transfers to different hospitals, nursing homes, and home care or community health care.1 Communication problems are the number-one cause of sentinel events, cautions Grena Porto, R.N., a patient safety expert and principal with QRS Healthcare Consulting, LLC, Hockessin , Delaware , who sits on the Joint Commissions Sentinel Event Advisory Committee. Because staff members hand off information about patients so often, they may not realize hand-off communication is a high-risk process. If staff members often do not allocate enough time to a hand-off, one or the other staff member may not get a complete picture of the patients situation, and important information can be lost. This is a common cause of error. The often-cited Institute of Medicine report Crossing the Quality Chasm asserts that patient hand-offs provide opportunity for error. The report notes that in a safe system, information is not lost, inaccessible, or forgotten in transitions.2To improve care, organizations should standardize hand-off communications and include an opportunity to ask and respond to questions. Following are five strategies to make sure hand-off communication occurs effectively and efficiently. 1. Use clear language. Avoid unclear or potentially confusing terms (shes a little unstable, hes doing fine, or shes lethargic). Define the terms youre using. Dont use abbreviations or jargon that could be misinterpreted. 2. Incorporate effective communication techniques. Limit interruptions, focus on the information being exchanged, and allocate sufficient time to this important task. Implement read-back or checkback techniques to make sure there is a common understanding about expectations. Encourage interactive questioning to allow for better information absorbtion. Keep the report patient centered and avoid irrelevant details. 3. Standardize shift-to-shift and unit-to-unit reporting. A consistent format increases the amount of information staff members accurately record and recall and improves their ability to plan patient care. Organize the data with a sign-out checklist, a script, or an at a glance status display. Provide cues of important information to pass on that is otherwise likely to be forgotten in the chaos of shift or unit changes. Keep the report concise and accurate. What you include in hand-off communications varies by setting and discipline but can include a summary of the patients current medical status, resucitation status, recent lab values, allergies, a problem list, and a to-do list for the covering physician or nurse. Get input from front-line staff to identify what should be included in the report. At Ohio State University Hospital , residents use MD Notes, a computerized sign-out program, to enter patient information and action plans for care. The process concludes with a face-to-face meeting.3 Organizations can also consider using the Situation-Background-Assessment-Recommendation (SBAR) technique to standardize communications. (See the February 2005 issue of Perspectives on Patient Safety for more information on the SBAR technique.) 4. Smooth hand-offs between settings. The transition between settings of care (such as from the hospital to home, community, or long term care) can be undependable. To prevent problems, communicate with the physician when a patient is admitted and update him or her whenever the patients status changes significantly. On discharge, provide the patient with information about discharge medications, discharge diagnoses, and results of procedures and labs. A simple follow-up call to the patient by a physcian, nurse, or pharmacist can prevent many postdischarge errors. 5. Use technology to your advantage. Communication systems that transmit information across settings and care providers bring consistency and coordination to care practices. For example, automated medication reconciliation between settings of care, such as physician office practices and the hospital, streamlines and increases safety during admissions and discharges. Electronic medical records can facilitate transitions by providing consistent, accessible information about patients and their care. Staff members should be able to readily access essential components of care, such as whether a newly ordered medication was administered, whether labs were done, or if a do-not-resuscitate order is in place.

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Joint Commission International Center for Patient Safety - Strategies to Improve Hand-Off Communica... Page 2 of 2
Keep electronic approaches interactive and effective by making time to answer questions or provide updates before signing off responsibility. References 1. Patterson E.S., et al.: Hand-off strategies in settings with high consequences for failure: Lessons for health care operations. Int J Qual Health Care 16:125132, Apr. 2004. Committee on the Quality of Health Care in America , Institute of Medicine : Crossing the Quality Chasm. Washington , DC : National Academy Press, 2001. Wilder B.: Study shows face-to-face shift changes could improve transfer of patient care information. Columbus Business First Sep. 17, 2004.

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This article is an exact reprint from Joint Commission Perspectives on Patient Safety, July 2005, Volume 5, Issue 7.

Partnering for Solutions in Systems Improvement

2005 Joint Commission International Center for Patient Safety - all rights reserved

http://www.jcipatientsafety.org/show.asp?durki=10742&print=yes

5/4/2006