Physician Handovers
Optimizing Physician handover: an important communication tool for patient safety.
Handover is defined as the communication of information between healthcare providers to support the transfer of patient care and maintain professional responsibility and accountability. Handover has been identified as a time in which errors are likely to occur. Absent or poor handovers have been shown to be an important preventable cause of patient harm, and are primarily due to poor communication and system error. These can lead to delayed decisions, repeat investigations, inaccurate diagnoses, wrong treatment, and poor communication with patients.
Handover is required in multiple different situations throughout the hospital. Handover should occur between ED physicians at the end of a shift , from ED physician to admitting physician/specialist, from physicians when starting or finishing call, or when transferring MRP from one specialty service to another. In some areas of our hospital a formal process for handover occurs while in others, more work needs to be done.
There has been some increasing attention in the literature regarding improving handover by optimizing the handover process and utilizing a standardized communication tool. I would be interested in the experience of the MHCD class in ensuring that timely, effective handover occurs in their institutions.
I think that most efficient way to improve handovers is to have standard structured information “table”, where you can see the most important information. Problems are caused at the borderline zone when there are different patients records, IT system. You must transfer the information putting it again to other IT system. I think that most of communication failures are caused by medication deviations. Therefore there should be a system, that you can also follow those failures and mistakes. In few years we would have the epic system, I hope that we would have benefit to improve the processes!?
Communication was classified as the third leading cause of sentinel events as per the latest JCI report, in addition to that, handover in both hand off and transition was always a challenging area, where you may encounter legitimate reasons for the non-compliance of the Health care providers (HCP), however those reasons need to be eradicated to ensure proper patient care in both quality and continuity.
From the last patient safety culture survey which was conducted for in our organization, one area was highlighted and need improve is handoff and transition. Depending on that survey results, the hospital’s Safety committee recommended to the CEO a proposal for a hospital wide project that aim to enhance professional’s handover of patient care and fill in the gaps in the last JCI visit’s recommendations as well of having the documentation of hand over and communication of staff nurses upon shift exchange, the proposal was approved and the PI was supported by the hospital executives and board of directors as a strategic project. My organization using ICIS since 2001. In 2016, we implemented handover and communication tool in Integrated Clinical Information System (ICIS) for nursing and Physician.
Along with the repeat backs and the read backs, we train all our staff to use the standardized tool SBAR (Situation – Background- Assessment – Recommendation) to maintain clarity in the handoff communications consistently. This tool is built into our EMR and used in all our settings. It focuses on patient, plan, purpose, problems and precautions. We find this tool to be easily adaptable in all our unit settings, meets our staff expectations, value added advancing quality & safety of care, and most importantly minimizes inefficiency by removing redundancies and uncertainties. Safety is our number one core value, and we encourage our staff to have a questioning attitude – Validate and verify to ensure safety.
We implemented the SBAR and read back procedure as welling our hospital. However, it worked reasonably well in physician to physician handover, but still isn’t fully adopted by nurses and other caregivers. Nurse-physician handovers and nurse-nurse handovers are equally important for patient safety. One shortcoming is that our EMR (EPIC) is not supporting handovers in the way we would like them to occur. My feeling is that the digital environment have to support the handover methodology you want to use and in our case we have to adapt this within EPIC.
Nevertheless , I would also advise to implement SBAR methodology and would emphasize the importance not to forget nurses and other caregivers.