Less distractions equal safer handoffs

Ideally, patient handoffs should cover a set list of information and be done face-to-face in a quiet room. When that happens, there's less risk for errors, according to research reported in the December 2005 Academic Medicine.

Darrell Solet, MD, now a cardiology fellow at the University of Texas in Dallas, and his co-authors evaluated the patient handoff process at four hospitals affiliated with Indiana University. They found handoffs varied a great deal in preparation, content and delivery method and identified major barriers to clear communication and how to resolve them.

"I was surprised at the number of ways physicians miscommunicate," said Dr. Solet, who was a resident at Indiana University School of Medicine in Indianapolis when he did the research.

To eliminate the lack of standardized patient information in handoffs, Dr. Solet and his co-authors developed a list of 11 elements to include. Among the suggestions:

• The reason for admission.
• Active problems and suggested therapies in case of complications.
• Pertinent laboratory data.
• Long-term plans for the patient, in case the family has questions.

To avoid the distractions of a noisy hallway, the most typical spot for transfers, Dr. Solet recommended finding a quiet room. And, despite intense time pressures, the most effective way to communicate is to meet in person.

The affiliated Indiana hospitals have made changes since the study. Residents now generate a standardized list of patient information for handoffs. The hospitals also created team rooms for the residents so the handoffs and other work can be done in quiet.

Tim Gillison, MD, a senior internal medicine resident at Indiana University, said these changes have streamlined what would otherwise be a time-consuming end to a long day.

"There's a lot of pressure to just be done with it and get out of the building," Dr. Gillison said.

"In reality that can be disastrous. If you forget to mention a patient's allergy or a crucial test that needs to be followed up on there can be serious ramifications," he said.