Better handoff communication reduces medical errors

Boston Children's hospital study says simple changes won't burden workflow
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A new study in The Journal of the American Medical Association shows hospitals can significantly reduce medical errors by adopting standardized communication during patient handoffs without burdening existing workflows.

Provider-to-provider miscommunication typically leads to medical errors, so study authors Christopher Landrigan, M.D., and Amy Starmer, M.D., of Boston Children's Hospital, designed a multi-faceted, bundled handoff system that features three components: standardized communication and handoff training, a verbal mnemonic and a new team handoff structure.

"Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan, but though vital to patient care, rarely receive communication or handoff training," Starmer said in the study announcement. "We sought to rectify that omission with this study."

The new process involves an interactive workshop for clinicians, where they practice giving and receiving handoffs under different clinical and real-world scenarios. Participants then learned an easy-to-remember mnemonic to ensure they verbally communicate all relevant information during the handoff. The team also restructured face-to-face handoffs to minimize interruptions and distractions.

Researchers worked with the hospital's informatics team to develop a structured handoff tool within the electronic medical record (EMR) to standardize the documentation of patient information transmitted during shift changes. The tool self-populates with standard patient information, eliminating the need for clinicians to manually enter and re-enter information in a document, which increases the potential for human error.

The team examined 1,255 patient admissions across two separate inpatient units at Boston Children's and measured the impact of the new handoff process on patient care and clinician workflow. Researchers said there were fewer omissions or miscommunications about important data during handoffs and medical errors decreased 45.8 percent. They also noted providers spent more time communicating face-to-face in quiet areas conducive to conversation, and spent more time at the bedside with patients

"We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude," Starmer said. "And even more surprising was that the systems were introduced so easily. Participants embraced the new systems, became more productive, and could then focus more energy to the job at hand."

Based on the results of this study, researchers have developed I-PASS, a medical education curriculum funded in part by a $3 million grant from the U.S. Department of Health & Human Services that is now rolling out to 10 teaching hospitals across North America.

"Our ultimate goal," Landrigan said in the announcement, "is to develop a robust handoff program that can be broadly disseminated across hospitals and specialties to reduce medical errors and optimize patient safety."

A study published last month in the Journal of Nursing Care Quality noted involving patients in the handoff process during nurse shift changes reduced medical errors and improved outcomes and the patient experience, FierceHealthcare previously reported.

To learn more:
- read the study
- here's the study announcement
- check out the I-PASS curriculum

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