http://www.medpagetoday.com/HospitalBasedMedicine/RiskManagement/16085

Residents who work longer hours are at risk for making more major medical mistakes. Sorry, but I’d rather be handed off in a systematic and reliable manner to a “fresh” doctor, than to have someone who’s had 3 hours of sleep in the past 36 hours making decisions about my life and health.

Seriously, if we can “pass off” systematically and reliably in other high-risk professions — and have been doing so for years — the medical profession can also learn this new skill. It is new, and it is a skill, so it will take time to adjust. Make the handoffs more reliable and systematic, and boom! — you have better health care for all — patients (and doctors!).

When shift change becomes so important that nurses, the pharmacy and consultants aren’t allowed to page during or otherwise disturb the process, we’ll master hand off.

It will never happen.

The handoff’s role in patient safety is coming under increasing scrutiny not just because reduced resident hours mean many more are occurring than in the past but because mishandled handoffs play such a large role in hospital sentinel events. The Joint Commission, which has made handoff quality a formal part of its accreditation reviews, conducted a study in 2006 that showed 67% of the sentinel events it identified that year arose from mishandled physician communication. The 800 or so such events it tracked that year were double the number in 2002.

The traditional standard for handoff documentation has been slips of paper, index cards or homemade document or spreadsheet templates, which many hospitals are seeking to upgrade in the wake of the Joint Commission’s new handoff requirement and guidelines published by specialty associations such as the Society for Hospital Medicine (developed, among others, by Dr. Arora quoted above).

A sure sign of the the handoff’s rising prominence is that healthcare technology companies have sensed an opportunity and there are now a number of specialized patient handoff applications available, as well as emerging efforts by the large EMR companies to address the handoff on their platforms. The shifting landscape is promoting an animated debate among technologists about how best to recreate the handoff in their software while addressing an imperative to improve communication.

In this atmosphere, there’s a sense everything is on the table with regard to improving the handoff and I take the increasing reference to nurses’ reports as a model for what works to be part of that. Nurses, for their part, have long been vocal about patient safety and their role in promoting it. That the nurse’s report – and the culture that supports it – are increasingly being held up as a possible model for residents and attendings to emulate is intriguing and shows how much ferment there is over handoffs right now.

(Full disclosure: my company, Lime Medical, makes a mobile patient handoff application).

ICU Bed 12: Patient X with abd abscess and renal failure
Bed 201: Patient Y with bilateral pneumonia
Stepdown Bed 10: Patient Z with PE and rectal bleeding

Perhaps, once medical residents tighten up the process, they can give the rest of us some pointers.