Term Paper: Patient Handoff Efficiency

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¶ … transferring vital records and responsibility of care from one healthcare provider to another is one of the most important parts of communication in health care. This important transfer point is known as a handoff. What makes a handoff effective is when a handoff supports the transition of important information and continuity of care and treatment. Sadly, there are many instances of ineffective handoffs where the first component to fail is safety. The Institute of Medicine (IOM) states: It is in inadequate handoffs that safety often fails first"(Aarts, & Nohr, 2010, p. 14) . This paper offers an overview of handoffs, gaps in the knowledge, and suggestions for improving the safety, efficacy and quality of handoffs.

To better understand how to improve and implement strategies for safer and more effective handoffs, one must know what is a Handoff. The first things to notice is the term "handoff" and the various words used to describe or associate handoffs. Such words could: handover, sign over, cross-coverage, and shift report. All of these words are used at times to describe handoffs and are also used in conjunction with other tasks such as staff shift change, etc. To aid in understanding the term "handoff" it will be used and defined as, "The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm" ("Clinical Handover and Patient Safety: Literature Review Report," 2005, p. 132) .

Handoffs can be complex and include a multitude of different kinds of communication. This could include changes in shift, meetings or discussions between care providers about patient care as well as the handling of record sign offs, etc. The handoff is also a means of transferring information, primary responsibility, and authority from one or a number of caregivers, to the staff or person in charge or on shift. As mentioned prior, in order for a handoff to be done properly, the handoff must provide critical information of the patient's current status, this may include communication methods between sender and receiver. The responsibility of the patient must also be transferred between one or several care providers to the next. All of this has to be done in an at times complex organizational system where patient safety is often jeopardized.

The complexity and nuance of the type of data managed, methods of transference and communication as well as the competency of various caregivers all encompass factors that may impact the effectiveness and efficiency of the handoff as well as patient safety. Because of the growing number of patients and cinicians involved in patient care, handoffs occur at a much higher rate than before. Health care delivery systems of before were far simpler and involved a small handful of staff. This growing and dynamic clinical environment creates room for mistakes when performing handoffs. Ineffective handoffs may contribute to gaps in patient care and breaches in patient safety. These breaches can include medication errors, wrong-sire surgery, and in extreme cases, patient deaths.

Research indicated nursing units may "transfer or discharge 40% to 70% of their patients every day"("Handoff Communications: Toolkit for Implementing the National Patient Safety Goal," 2008, p. 22) . This paints a clear picture of the frequency of handoffs occurring daily and the possible breaches in patient safety. Another reason why handoffs can be complicated in this day and age is the growing number of specialists. Doctors, nurses, staff of specific fields such as Oncology, are used to treat certain ailments, such as cancer. These specialists are necessary and require handoff from primary care physicians or emergency room personnel.

This kind of care is ever expanding to improve patient outcomes and enhance healthcare delivery. However, it at times contributes to higher rates of accidents and risks while also promoting fragmentation of care and ineffective handoffs. Organizations, press, as well as other hospitals shine a light on the increasing rate of ineffective handoffs. The reason being is ineffective handoffs can lead to a myriad of patient health problems that will add more cost to the hospital or clinic servicing the patients and can lead to possible lawsuits depending on the severity of the errors. What contributes to fumbled handoffs? A big contributor to ineffective handoffs is lack of communication or communication breakdown. Communication may be attributed to handoffs between different disciplines as well as poor use of sign-out sheets. (Missing allergy information, incorrect weight, lack of detail in diagnosis, etc.)

One study found multiple mistakes in 67% of the sheets. These mistakes are sometimes made by new staff and nurses in particular noticed the problem with improper handoffs and attributed it to incomplete or missing information.(Lippincott Williams & Wilkins, 1989, p. 3) Acute care hospitals in particular are known to have complex organization strategies resulting in difficult communication and lack of communication between appropriate healthcare providers. An example of this would be doctors not being able to identify the nurse in charge of the patient. Due to the ever expanding number of specialties and clinicians providing care to a single patient, nurses and doctors reported difficulty in identifying or contacting the correct healthcare provider. (Spinewine, & Claeys, 2013, p. 4)

A successful handoff is largely dependent on the level of interpersonal communication skills, level of experience and knowledge of the caregiver. Research indicates the increased variability in quality of handoffs will increase due to lack of instruction on handoffs. Sources state only 8-10% of medical schools instruct on "how to handle and handoff patients in formal didactic session"(Vincent, 2010, p. 32-33) . Another reasons there are problems within handoff is the lack of awareness of communication styles. Physicians and nurses communicate differently.

Ways in which the communicate differently are as follows: Nurses are focused on broad instructions vs. physicians who are focused on details pertaining to critical information. A technique that seeks to close the gap between the differing communication styles of both nurses and physicians are the situation, background, assessment, recommendation (SBAR) briefing model. SBAR is defined as follows: "SBAR promotes better communication in healthcare. In most cases nurses and physicians communicate in very different ways. Nurses are taught to report in narrative form, providing all details known about the patient. Physicians are taught to communicate using brief "bullet points" that provide key information to the listener."

Here is an example of a call to a physician using SBAR:

Introduction

Dr. Jones, this is Deb McDonald RN, I am calling from ABC Hospital about your patient Jane Smith.

Situation

Here's the situation: Mrs. Smith is having increasing dyspnea and is complaining of chest pain.

Background

The supporting background information is that she had a total knee replacement two days ago. About two hours ago she began complaining of chest pain. Her pulse is 120 and her blood pressure is 128/54. She is restless and short of breath.

Assessment

My assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.

Recommendation

I recommend that you see her immediately and that we start her on 02 stat. Do you agree?" ("What is SBAR? | Situation Background Assessment recommendation | What is SBAR Communication? - Safer Healthcare," n.d., p. 1)

Other ways to improve handoffs are using clear language. If staff learns to avoid use of abbreviations or terms that can be misinterpreted it will promote effective communication and decrease instances of confusion that often happens in these circumstances. An example of this would be: during the reconciliation process, a nurse instead of writing down the patient's medication instructions as take one every other day, writes is as QOD. Abbreviations such as these can be misinterpreted as QD or take once daily.

A second method is to use effective communication techniques. This can be done by limiting any and all interruptions unless there is an emergency. Implement and utilize read-backs or checkback technique such as when a nurse in a rush forgets to report to the oncoming nurse that a patient injured herself right before shift change. Taking the necessary measures to ensure incidences like these do not happen are critical. Nurses along with other medical personnel could be given 15 minutes before their shift ends to communicate or report any updates or changes.

Another method to take into consideration is standardize reporting shift-to-shift and unit-to-unit. This handoff report with a one-page tool is used for each patient, providing a comprehensive, structured approach in giving important information and updates on new and recovering postoperative patients. This method is used or should be used in high traffic, busy units such as the emergency department. Patients in the emergency department have to be discharged or moved quickly out of the ED to an inpatient unit. This handoff process, which includes a phone call to the receiving unit, allows assignment of an admission nurse to minimize delays on the receiving unit.

Technology is a great way to enhance communication and the implementation of electronic records supports prompt and efficient transmission of patient information. The use… [END OF PREVIEW]

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