Very rarely will only one physician be responsible for a patient over the course of his or her entire medical treatment. When that responsibility is passed on to another caregiver, it is known as a “patient handoff.” Responsibility can be transferred from institution to institution, from one physician to another or even from nurse to nurse (i.e. during shift changes).
The goal is to provide well-timed and accurate information about a patient’s treatment, condition and any recent or anticipated changes in their care plan. Unfortunately, this goal is being stymied by an escalating trend towards incomplete patient information, missing tests and poor communication among physicians, and is the result of an influx of available professionals in the healthcare field, according to a recent report by American Medical News. Juxtaposed with this increase in issues is an increase in the risk for legal liability. In one case, a “38-year-old woman detected a lump in her breast and was referred by her primary care physician to a surgeon. The surgeon found no mass, but recommended she be re-examined in one month. Each physician assumed the other would do the follow-up.” Nine months and no follow-up later, the patient was diagnosed with breast cancer.
As a personal injury lawyer, I know it is extremely important to have good hand offs of patients. Alan Lembitz, MD, vice president of COPIC, a professional liability insurance company based in Denver, Colorado, suggests that health professionals combat legal risks by being more aware of potential communication failures and creating safety checklists. Although Mr. Lembitz is correct in the need for better handoffs, the reason he gave is incorrect. The reason to improve patient handoffs is patient safety. Reduced legal liability is simply a beneficial side effect. In other words, do the things that make a patient safe because it is the right thing to do and a reduction in legal liability will naturally follow. The Hospitals and Health Networks has compiled a list of 10 tips for effective handoffs:
1. Allow for face-to-face handoffs whenever possible;
2. Ensure two-way communication during the handoff process;
3. Allow as much time as necessary for handoffs;
4. Use both verbal and written means of communication;
5. Conduct handoffs at the patient bedside whenever possible. Involve patients and families in the handoff process. Provide clear information at discharge;
6. Involve staff in the development of handoff standards;
7. Incorporate communication techniques, such as SBAR, in the handoff
process. Require a verification process to ensure that information is both
received and understood;
8. In addition to information exchange, handoffs should clearly outline the
transfer of patient responsibility from one provider to another;
9. Use available technology, such as the electronic medical record, to streamline
the exchange of timely, accurate information; and,
10. Monitor use and effectiveness of the handoff. Seek feedback from staff.
While successfully implementing best practices isn’t always easy, as of November last year, a Joint Commission quality improvement initiative had helped five hospitals around the country cut their rates of so-called defective handoffs by an average of 52%. Institutions nationwide might benefit from taking advantage of this or similar programs. In the meantime, patient themselves can actively become involved in the handoff process by specifically requesting full disclosure from their managing physician enabling them to better spot when something a new provider does or says is incongruous.