Communication and Handoffs

1. Communication and Handoffs Cathryn Caton, MD, MS Medical University of South Carolina January 22, 2013

2. Goals and Objectives • Define clinical handoffs • Demonstrate the importance of effective handoffs • Understand key components of an effective standardized handoff • Discuss the handoff environment and communication techniques

3. Clinical handoff • A clinical handoff is the temporary transfer of care and responsibility from the primary physician to the covering physician • Verbal • Written • Increased handoffs with reduced work hours • Many training programs do not have standardized handoff training programs • 75 handoffs/month /team here at MUSC • Improving handoffs is a national patient safety goal

4. Handoffs and patient safety • Associated with adverse clinical outcomes • Sentinel events commonly results from communication breakdown – 65 % of the time • 92% of communication errors occur during verbal communication between 1 transmitter and 1 receiver • Errors surround omission of content or lack of direct discussion

5. Primary Team Consult Team Transferring team Attending Attending Attending Fellow Fellow Fellow Resident/Intern Resident/Intern Resident/Intern Student Student Student

6. Ideal handoff components • Face to face interaction for verbal communication • Updated written or computerized information (use actual dates) • Clarity about the patient’s current condition, including severity of illness • Anticipating changes in patient condition with specific interventions • Minimal interruptions • Structured format (time, place)

7. Summary of Themes from “White Papers” • Need for training • Ensure adequate time for handoff • Reduce interruptions • Keep information updated in template or technology solution • Facilitate interactive questioning • Focus on ill patients • Delineate actions to be taken

8. Verbal Signout

9. Written sign out

10. Key Messages • Good handoffs • may reduce sentinel events / improve patient safety • Use standardized formats • Interactive • Focuses on ill patients • Provides anticipatory guidance

11. References • Joint Commission Sentinel Event Database • Greenberg CC. J Am CollSurg 2007; 204;533 • Arora V. QualSaf Health Care 2005; 14:401 • Arora VM. J Hosp Med 2009; 4:433