Handoffs are a crucial moment in a patient’s care, when poor communication can lead to errors and harm, says Marian Altman, PhD, RN, CNS-BC, CCRN-K, clinical practice specialist with the American Association of Critical-Care Nurses (AACN).
As evidence of the importance of effective handoffs, Altman notes The Joint Commission (TJC) requires hospitals to develop a standardized process for handoff communication regarding patient information.
“Handoffs are key to making sure that each patient receives consistently high-quality care, from provider to provider, from shift to shift, and from unit to unit,” Altman says.
“A handoff is a transfer and acceptance of patient care responsibility achieved through effective communication,” TJC noted. “It is a real-time process of passing patient-specific information from one caregiver to another, or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.”
This definition was part of TJC’s Sentinel Event Alert 58: Inadequate hand-off communication. TJC cited study results that estimated communication failures in U.S. hospitals and medical practices were at least partly responsible for 30% of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years.
“Communication errors are the No. 1 cause of sentinel events in a hospital. Handoffs are important to prevent errors of omission, and also provide structured communication between providers,” Altman says. “A poor patient handoff can contribute to vital information being forgotten or missed, leading to delays in care, extended hospital stays, and confusion. Poor handoffs may also result in nursing overtime. Poor handoffs also may affect a patient’s perception of quality, thus affecting HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] scores.”
Most hospitals use standardized tools and methods to facilitate handoffs, Altman says. These can include forms, checklists, and mnemonics such as SBAR (situation, background, action, response) and I-PASS (illness severity, patient summary, action list, situation awareness, and synthesis by the receiver).
“The tool alone is not a solution,” Altman notes. “How individuals use them is the true measure of their effectiveness. Skilled communication during handoffs ensures that each clinician feels confident that the patient is in good hands.”
A face-to-face handoff, instead of a paper handoff, is encouraged to allow the receiver to ask clarifying questions. It also is important to have uninterrupted time during the handoff.
AACN regularly studies patient handoffs, Altman notes, which established the AACN Clinical Scene Investigator Academy in 2012, as a hospital-based nurse leadership and innovation training.
SOURCE
- Marian Altman, PhD, RN, CNS-BC, CCRN-K, Clinical Practice Specialist, American Association of Critical-Care Nurses, Aliso Viejo, CA. Phone: (800) 809-2273.