Patient handoffs increase medical malpractice risk

Patient handoffs increases the risk of medical errors.

It’s a phenomenon during residency, as doctors are mandated to leave the hospital after a defined number of hours.  But it’s also prevalent outside of an academic setting, as more institutions use hospitalists for their inpatients.

This increases malpractice risk.

Perhaps the biggest problem with hospitalists is the transition during discharge, when the patient is handed back to the primary care physician’s care.

Various questions inevitably arise: “Did the primary doctor make sure that the hospitalist knows of the patient’s allergies? Did the hospitalist speak to the primary when the patient was admitted and discharged? Did the hospitalist convey the need for a follow-up computed tomographic scan in 3 months? Was there a delay in faxing the discharge summary? Does the patient know who he’s supposed to contact if complications arise?”

And what if disaster strikes, and the patient suffers because of a communication lapse?

It’s a fertile ground for malpractice:

If something goes wrong, both the hospitalist and primary doctor will be sued. The duty to provide adequate follow-up is shared … It’s a poor defense in a malpractice case to argue, “I assumed the hospital (or the primary) was handling that,” when the injury could have been prevented if the 2 sides had communicated better. Jurors are rarely forgiving when physicians point fingers of blame at each other.

Doctors are becoming more specialized and that further fragments care. It’s imperative that patients not fall through the cracks, and communication between doctors be a top priority.

Failing to do so risks injuring patients and brings the specter of malpractice closer to everyone involved.

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  • ninguem

    I’d have thought it would be a wash. Sometimes causing errors, sometimes a fresh set of eyes finding a problem.

  • Doc99

    Shorter Housestaff work hours … no good deed goes unpunished. And after all this time, there’s little real evidence of a benefit.

  • Michael Kirsch, M.D.

    Of course, handoffs increase our malpractice liability. It’s worth mentioning that it jeopardizes medical quality also.

  • Vineet Arora MD

    This is why we need to train students and residents how to perform handoffs. Students spend a lot of time learning how to interview patients, but very few will learn how to effectively communicate critical patient information to other physicians transitions before, during and after hospitalization. We also need to train practicing physicians. For example, handoffs are now a ‘core competency’ for hospitalists. We have been working on modules to train students to faculty to do this better. For more information, email

  • Ohio malpractice

    Vineet Arora MD

    I totally agree with that student thing.

  • inchoate but earnest

    leave it to status quo apologist/heroic solo clinician fantasist Kirsch to acknowledge the “problem” while failing to suggest any solution whatsoever. One supposes his solution is some tired variant of “give the heroic solo clinician more unbridled latitude and all will return to that glorious time when results for people in these circumstances was immeasurably (emphasis on immeasurably) better”.

    It’s more unusual that Dr. Kevin would leave us hanging in much the same way…..

  • Michael Kirsch, M.D.

    @inchoate, kindly note that I am not a solo clinician. Pleased to be in Dr. Kevin’s company.

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