In football, what are the chances of a fumble when the quarterback hands off to the running back? In medicine, what are the chances of a 'fumble' when one doctor hands off the patient to another doctor? Quite high in both situations, and becoming more frequent in medicine.
The increasing fragmentation of patient care is a big part of the problem. Not too long ago, the primary care physician would follow the patient from hospital admission to discharge. Today, the patient may be cared for by five or six physicians during one hospitalization: an emergency room doctor, three or four hospitalists, perhaps two or three consultants. Each exchange increases the risk that vital information will be overlooked.
An estimated 80% of serious medical errors are caused by miscommunication between caregivers during the patient handoff, according to the Joint Commissions Center for Transforming Healthcare. "There are 4000 handoffs a day in a typical teaching hospital," says Joint Commission President Dr. Mark Chassin. "If 90% go flawlessly, that's still 400 failures per day." When a lawsuit occurs, everyone whose name is in the chart will have to defend their actions, including how effectively they communicated with their peers at the time of handoff. "Almost all claims have multiple defendants and points of contact," says Dr. Alan Lembitz of the liability carrier COPIC.
How can we make handoffs less prone to error? First, we have to acknowledge that this is a really serious problem. When our colleagues in the operating room started using checklists, their error rates went down significantly. Creating a standardized checklist to be used at the time of a handoff could help as well. For example, a handoff checklist might include this basic information:
~ differential diagnosis
~ medications and the patient's reaction to these medications
~ pending laboratory and imaging studies
~ names and contact numbers of all caregivers
~ names of key family contacts
~ physician now assuming primary responsibility for the patient
Other suggestions: Make every effort to communicate with the next provider face to face, and make sure the next caregiver not only receives and reads your report but understands it. Remember: Information is not communication.
(Reference: Malpractice Threats in Well-Intended Patient Handoffs. Medscape, October 4, 2012).
Ken Teufel is the Medical Director for Interim Physicians