Standardizing Handoff Communication

Handoff Communication

The Joint Commission and the Agency for Healthcare Research and Quality have been concerned about care transitions for many years. Poor handoff communication has resulted in higher expenses, unnecessary work backlogs, and missed opportunities to provide appropriate care. As a result, both firms highlight the need of maintaining open lines of communication during the handoff process.

During the handoff, crucial patient information is shared between caregivers in real time. Nurses must be able to communicate effectively with one another in order to provide accurate information about the patient’s health and provide continuity of treatment. The following information is typical of a handoff: 

  • Patients who have completed or are presently undergoing treatment, as well as their medical histories, hemodynamic status, care plans, and any other relevant information 
  • During this information transmission, the great majority of communication failures occur. A contaminated handoff increases the likelihood of a bad result for the patient. According to Wheeler, more than 70% of fatal medical mistakes are caused by a lack of handoff communication. 
  • Bedside handoffs can increase the patient’s and caregiver’s direct visual and verbal connection. Handoffs at the bedside can help patients and families become more active in their care.

Patient hand-offs are dangerous. A study done in 2016 discovered that communication disruptions in US hospitals and medical practices caused around 1,750 fatalities over a five-year period. Every day, approximately 4,500 people exchange information in a typical teaching hospital, raising the potential of misinterpretation.

To get the greatest surgical outcomes, OR directors must ensure that proper hand-off communication happens with millions of patients each year.

According to Stephen Knoll, associate director of Joint Commission standards interpretation, there are several care hand-offs. “We have a recovery room, a holding area, an emergency room, and an intensive care unit (ICU) all within walking distance of each other, in addition to the OR. To ensure patient safety, proper information exchange is necessary during all hand-offs.”  

Patients and their families should be engaged in the handoff process, which should be as seamless as possible between outgoing and entering nurses at their patient’s bedside. Nurses must communicate often in order to ensure a smooth transition of patient care.

Normative Functions

There is no “one-size-fits-all” material when it comes to handoff information for certain medical groups. It’s easier to get your argument through if everyone is using the same language and standards. Medical competence, patient care role (primary or consultative), environment, and medical/social complexity all influence the information that must be shared between doctors during shift changes.  Primary care demands a comprehensive picture of the patient’s health, unlike consulting services, which sometimes provide more specialized information. It’s tough to pin down a particular medical organization’s standards because there are so many of them.  Communication between sender and recipient is made more efficient through standardization. Handoffs are only as effective as their execution, and this includes both the process and the content.  

Using a checklist, template, acronym, or mnemonic to assist the sender in recalling information is typical practice in a broad variety of businesses. Rather of focusing on the mechanics of handoffs, this study will look at technological options that might improve their substance. The most effective handoffs incorporate both written and vocal material, as well as printed information (preferably from the EMR). By employing an auto-populated form (e.g., demographics, medications, prescriptions, allergies, surgical history, etc), doctors may focus on the specifics of their patients’ treatment and contingency plans. Officials in charge of quality and safety, residency programs, and information technology may work together to determine the best ways to connect with diverse patient groups, Patient Handoff Tool, hospital units, and institutions. These technologies have the potential to make consistent handoffs easier.

During their shifts, a huge number of doctors are responsible for the health and safety of their units as well as the hospital as a whole. Prior to handoff, clinicians must consider any projected increases in the unit’s or hospital’s capacity, as well as the patients’ acuity.

Processes of standardization

It is not only about the substance when it comes to handoff communication. The following human factors have been shown to improve handoff performance across all disciplines.  

Non-emergency situational disruptions must be kept to a minimum. When sign-out locations are consistent, the sender, recipient, and other care team members recognize the importance of handoff communication. When participants are not disturbed and non-emergency tasks are delayed, handoffs become easier. Sign-outs are best done in a quiet, distraction-free environment. Although sign-outs are not permitted in the operating room, other types of physician handoffs, such as those between anesthesiologists, are widespread.

Additional medical personnel should be called in if a patient has a high level of complication (eg, nurses and home workers).  

Teamwork benefits patients in intensive care units (ICUs). There will be a chance to address any changes or concerns with the patient’s new physician, who will be in charge of his or her care. If there are any issues or changes in care, the patient and family are given the chance to express their concerns and are kept up to speed on previous shift information. Eliminating bedside handoffs can give significant opportunities for patients and their families to participate. 20 Patients and their families are only introduced to new doctors as part of the bedside sign-out routine.

Make the passing of the baton a spectacle. Oral and written data interchange should occur as much as possible during the sign-out procedure. Handoffs should be replaced with continuous communication (phone or video conferencing). Written or audio handoffs, without vocal communication and real-time interaction between clinicians, increase the risk of incomplete or confused assessments and plans being passed on to the next clinician. Allowing the receiver to ask questions is the most effective way of signing out. By requiring the receiver to read and verify the sender’s communication, the likelihood that all relevant information is transmitted and understood is raised. To comply with HIPAA privacy regulations, all patient data received by text or email, including sign-outs, must be encrypted.  

Create a clear chain of responsibility between the doctors who are sending and receiving treatment. Transfer of patient care must be communicated effectively in order to avoid several physicians making clinical judgements and delivering orders at the same time. Confusion and discontent are decreased after sign-out since both the sender and receiving physicians are aware of their respective obligations (eg, calling a consultant). 

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