Patient handoffs

September 24, 2008

A major downside to capping resident work-hours is increasing the number of patient handoffs between doctors.

Further decreasing allowable work-hours to 56 hours per week will only exacerbate the problem.

A survey of MGH residents suggested that this practice led to significant patient harm, almost as serious as medication-related events:

More than half of the 161 medical or surgical residents who responded to the anonymous survey said they recalled at least one occasion in their last month-long rotation when a patient suffered from flawed handoffs. About one in nine said the harm that resulted was significant.



Related posts:

  1. Patient hand-offs are a source of serious patient harm
  2. How to reduce the risk of medical errors from patient hand-offs
  3. A 48-hour physician workweek will kill patients
  4. Old-school doctors on resident work-hour restrictions
  5. Resident work hour restrictions: Good for nothing?
  6. Would you want a tired doctor who knows you, or a rested one that doesn’t?
  7. How work-hour restrictions harms resident surgeon training


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{ 6 comments }

1 ERP September 24, 2008 at 12:16 pm

This is the time in the ER where most errors occur. Signout. Unfortunately, working 24 hours a day until the patient is discharged or dies is not a good option.

2 Ileana September 24, 2008 at 1:11 pm

Or they can start standardizing their handoff process and making it better suited to changing shifts.

I know they are overworked and it’s difficult to add yet another improvement process in the mix, but in the long run, you guys need to understand that residents need a life too and better rested residents with better handoff processes will eventually lead to fewer mistakes than before the 80 hours/week threshold.

3 Charles R. September 24, 2008 at 1:12 pm

Would not better, more specific, easily-scanned, electronic patient records help?

4 Anonymous September 24, 2008 at 2:34 pm

Anecdotes are not data. Why do doctors refuse to believe this?

Evidence suggests hour limits better for patients.

http://www.medicalnewstoday.com/articles/121683.php

5 Anonymous September 25, 2008 at 9:52 am

A single-institution study is an anecdote? Ironic that anon cites another single-institution study as counterpoint. The following 2 studies are the real deal. Nothing beats national data when you’re trying to evaluate the effect of a national intervention.

http://jama.ama-assn.org/cgi/content/abstract/298/9/975?ct

http://jama.ama-assn.org/cgi/content/short/298/9/984

6 Anonymous September 25, 2008 at 7:53 pm

Excuse me, the gall bladder study was in fact a study with real data, not a survey, which is the detritus of all empirical research.

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