Imagine you are a physician at a hospital just coming in for a shift. You get there and go to see the physician you are taking over for. The clinician you meet is exhausted and is rushing to leave. You stand at a table in the hall, and you keep hearing the phone ring, and people talk, and monitors beep. It’s kind of loud, so you try really hard to focus on what the other person is saying. However, they are talking so fast that you barely register the information, let alone have time to ask questions. Suddenly, as quick as they started the handoff, the physician finishes talking. You understand that they want to leave, but now you are left in a daze. Which patients are you supposed to be monitoring most closely? Is there anything that needs to be done first? How many patients do you even have?
Handoffs can be a big source of medical errors, as communication failures contribute to up to 50-80% of sentinel events. This can have negative effects on the hospital and the patients. A 2016 study estimated that communication failures in U.S. hospitals and clinics were at least partially responsible for 30 percent of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years.
Because of problems with communication during handoffs, The Joint Commission released guidelines for improving handoff processes. One common example is the mnemonic I-PASS, a standardized handoff process that complies with the guidelines and which has been adopted by many organizations since. Adding on to these processes can help improve the handoff further. Keep reading for more suggestions on how to improve handoffs:
1. Use Multiple Modes of Information Sharing
The most effective way to communicate is to share the information in multiple ways. The most common way to do this would be doing a verbal and written handoff. For those in the same physical location, verbal handoffs can be done in person. Verbal handoffs should also be done when clinicians are virtual or remote. For these handoffs, having both clinicians look at the real-time patient note during the verbal handoff can help keep everyone on the same page.
Standardization is key! Standardize the order of verbal presentations and the location of written information to help the receiver know what to expect. Receiving information that conforms to a known structure facilitates memory and reduces cognitive burden. If any abbreviations are used, they should be common and standardized. You can even standardize the physical location where handoffs are done.
3. Find a Quiet Location
When giving a verbal handoff, look for a quiet location with minimal distractions and interruptions. Sometimes interruptions are unavoidable. If an interruption lasts more than ten seconds, consider restarting that patient’s verbal handoff. It may be a good idea to have a specific place for handoffs to happen so that others know that when people are there, they are doing a handoff. A quiet location is also important for virtual handoffs. Make sure there is a stable internet connection and try using headphones to reduce background noise.
4. Severity Assessment
Both verbal and written handoffs should start with a severity assessment. This helps frame the patient’s information for the receiver, and may prime the receiver to ask more questions or keep a close eye on the patient.
5. Empower Receivers
Handoffs should have time for questions and read-backs. Repeating information and being exposed to it multiple times improves retention. This ensures that both parties are on the same page, reducing the risk of misunderstandings that lead to errors. Receivers should be empowered to ask the speaker to slow down, repeat information, or explain something a different way. Most importantly, receivers should ask questions and repeat back key points.
To learn more about handoff best practices, check out Dr. Airan-Javia’s session at AAIM “From Ugh to Ahh: Implementing I-PASS at Penn Medicine “