practice partner
When can handovers be
problematic?
• A busy work environment with many
interruptions that lead to abbreviated and
distracted communications and impaired
recall
• Handovers that occur at a distance, either
by phone or electronically where collegial
exchanges are minimized or non-existent
• Limited interactive communication, where
all parties have the opportunity to question as well as confirm understanding of
information given and received
• Lack of “Readback” of critical information
The consequences include:
• Missing critical information in history and
or physical during handover
• Unclear communication of patient’s
current status as well as anticipated
complications
• Confusion over responsibilities such as
Most Responsible Physician (MRP) and
those responsible for follow-up on investigations and communications with team
members, patient, and family
• Inattention to the potential impact of
biased or ambiguous communication
A patient whose care has been compromised
may complain to the College. Certainly as
the scenarios earlier demonstrate, handover
of care can have unexpected and serious
consequences for patients. Many things can
complicate what might otherwise be a routine
transfer. Handovers that take place at the
end of a shift, before a vacation or prolonged
absence, or from one team to another are
particularly susceptible to compromises in
patient safety.
The College’s Inquiries, Complaints and
Reports Committee, in reviewing such
complaints, has repeatedly noted the crucial
importance of excellent communication and
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documentation, so that everyone (the physician who is departing, the physician who is
taking over, and other health professionals
involved in care) clearly understands who is
Most Responsible Physician (MRP) at any
given time.
Fortunately, hospitals and health-care
systems are working hard to address the issues. One notable success story comes from
Boston’s Children’s Hospital (JAMA, Dec.3,
2013) where a research group assessed the
impact of instituting a formal handoff protocol in resident teaching units. The study
intervention included a communication training session, a checklist to standardize data for
exchanges, mandating in-person meetings
that included all team members involved in
the handover, as well as a computerized tool
integrated in the patient medical record. The
hospital was able to demonstrate a 33.8%
reduction in medical errors with no adverse
effect on resident workflow.
Improving communication during handovers has become a priority in Canada, too.
Several groups within medical education
and patient safety spheres have tackled the
issue of improved patient safety during handovers. Through their efforts, multiple tools –
including mnemonic techniques to structure
communications – have been developed to
improve communications during handovers.
Some of the mnemonic techniques t