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How to Improve Patient Safety with the Patient Handoff

How to Improve Patient Safety with the Patient Handoff

Poor communication is a leading cause of medical errors in this era of collaborative care. Effective communication strategies can help facilitate the continuity of care, prevent errors, and provide a safe environment for the patient. Patient handoffs—the transfer of patient information and knowledge, along with authority and responsibility, from one or more clinicians to another clinician or team of clinicians during transitions of care across the continuum—are a predictable communication event that can improve overall communication and help reduce the number of preventable medical errors.

The American College of Obstetricians and Gynecologists encourages a standardized approach to the patient handoff.1 The process should include interactive communication, limited interruptions, procedures for verification, and opportunities to review relevant historical data. The physical environment, confidentiality, language, organizational culture, communication method, and documentation are all factors that should be addressed during the handoff process (Table 1). Using structured forms of communication, such as the Situation-Background-Assessment-Recommendation (SBAR) technique or the mnemonic “I Pass the Baton” (Table 2), may also be useful.

Table 1. Communication Factors for Improving Patient Handoffs

Factor Considerations
Physical environment Choose a place with minimal distractions (ie, avoid busy hallways or offices in which interruptions are likely); consider clinical acuity of the patient’s condition when choosing the circumstances, the setting, and the content of handoff communication; conduct handoffs in patients’ rooms as appropriate.
 
Confidentiality Comply with the Health Insurance Portability and Accountability Act by ensuring that only clinicians involved in the patient’s care can hear or view protected health care information.
Language Use standardized medical terminology to avoid misunderstandings that may occur when colloquialisms are used; avoid use of abbreviations.
Organizational culture Identify a primary person or team responsible for each patient, as well as a backup person or team in case the primary contact is unavailable; encourage all team members, from nurses to first-year residents to senior attending physicians, to participate and contribute without reluctance; senior physicians should set examples by listening attentively and eliciting concerns from all team members.
Communication Both verbal and written communications comprise the most effective
Method Patient handoff; face-to-face exchanges are preferred because it allows for expression of nonverbal information through body language and facial expressions; give priority to patient handoffs unless there is an emergency.
Documentation If electronic medical records are not being used, write legibly to avoid misinterpretation by other team members; always include in the patient’s medical record pertinent demographic information, a brief history and results of the physical examination, an active problem list, medications and allergies, pending test results, ongoing or anticipated therapy, key patient values and preferences, and any other information deemed critical; if circumstances warrant, also include code status, psychosocial status, family issues, and long-term care issues.

Data from Committee opinion no. 517: communication strategies for patient handoffs. Obstet Gynecol. 2012.1

 

Table 2. “I Pass the Baton” Mnemonic for Improving Patient Handoffs

I Introduction Introduce self and role or job (include the patient)
P Patient Name, identifiers, age, sex, location
A Assessment
Present chief complaint, vital signs, symptoms, and diagnosis
S Situation Current status or circumstances, including code status, level of (un)certainty, recent changes, and response to treatment
S Safety concerns Critical lab values or reports, socioeconomic factors, allergies, and alerts (eg, falls or isolation)
The    
B Background Cormorbidities, previous episodes, current medications, and family history
A Actions What actions were taken or are required? Provide brief rationale
T Timing Level of urgency and explicit timing and prioritization of actions
O Ownership Who is responsible (person or team) including responsibilities of patient or family?
N Next What will happen next? Are there anticipated changes? What is the plan? Are there contingency plans?

From Committee opinion no. 517: communication strategies for patient handoffs. Obstet Gynecol. 2012.1

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References

Reference
1. Committee opinion no. 517: communication strategies for patient handoffs. Obstet Gynecol. 2012;119(pt 1):408-411.

 
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