Due to hospital shift changes, patient handoffs occur with high frequency in hospitals. It’s during these periods when the care of patients is transferred from one physician to another when communication between healthcare professionals is vulnerable to error. Miscommunication during a patient handoff could mean that key information about a patient’s condition gets lost in the shuffle.
In a research letter published in the JAMA Internal Medicine, researchers from Brigham and Women’s Hospital in Boston and Harvard Medical School contend that the use of a web-based handoff tool can improve communication and reduce medical errors.
For the study, the researchers, Stephanie Mueller, M.D. and Jeffrey Schlepper, M.D., both from Brigham and Women’s Hospital and Harvard, and Catherine Yoon, from the division of general internal medicine at Brigham and Women’s Hospital, evaluated the association of a technology tool and training for healthcare professionals in rates of medical errors in adult medical and surgical patients.
In a commentary published in JAMA Internal Medicine as a companion to the study, Adam Schoenfeld, M.D. and Robert Wachter, M.D., with the department of medicine at University of California, San Francisco, noted that miscommunication during handoffs is one of the most common preventable sources of adverse events in the hospital. “Since 2033, when resident duty-hour restrictions were implemented in the United States, handoffs have become more common. Efforts to make handoffs uniform, usually involving standardized sign-outs, have improved safety and have become widely accepted,” Drs. Schoenfeld and Wachter wrote.
The researchers analyzed 5,407 patients on three general medicine services and two general surgery services at Brigham and Women’s Hospital from November 2012 to February 2013, when the tool was implemented, and then post-implementation to February 2014.
To evaluate the tool, the researchers surveyed residents at the end of their shifts who worked “nightfloat” — midnight to 7 a.m. — and “twilight” — 4 p.m. to 12 a.m. They checked for possible medical errors, and then rated those errors in terms of how avoidable they were.
Key features of the web-based tool included auto-population of patient information from the existing electronic medical record, templates fields that directed users to include key pieces of clinical information and merging of workflows such that users updated components of the handoff and progress notes simultaneously, according to the study. Healthcare professionals also were trained in using the tool and also trained in best practices in verbal handoffs correlated with web-based handoff tool.
The study results indicated that the number of medical errors dropped by almost half they ear after the hospital introduced the IT tool and trained healthcare professionals on how to use it. According to the study, 77 medical errors were detected before the intervention versus 45 medical errors after the web-based tool was implemented.
“We found that implementation of a web-based handoff tool and training for healthcare professionals was associated with a significant reduction in rates of medical errors, driven largely by a reduction in errors attributable to communication failure and errors that occurred during end-of-shift handoffs,” the study authors wrote. “It is possible that the tool was more adept at improving the end-of-shift handoffs, although it is also plausible that our study was underpowered to examine end-of-rotation handoffs, supported by the trend toward reduced errors observed in that subgroup.”
While the findings are somewhat limited given that it was a single-site study, the study authors also note that the components of the handoff tool are easily adaptable to other sites, including those that use vendor EHRs.
Drs. Schoenfeld and Wachter, in the accompanying commentary, noted that it’s unlikely that any one handoff tool will fit all hospital settings perfectly. “However, certain key features of handoff tools may be important for success. For example, auto population of core fields from the electronic medical record is likely to improve efficiency and satisfaction, as well as prevent the communication of misleading or erroneous information (include medications, diagnoses, and resuscitation preferences),” they wrote.
“As hospital care is increasingly shift based, a clear and efficient handoff process is vital. The study shows how web-based handoffs tools may improve hospital workflow and patient safety, but only if they are carefully built and integrated into existing systems,” they concluded.
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