How Clinicians Can Make Handoffs Safer and Faster

Handoffs are an unavoidable reality for patients in hospitals.

Yet every year, clinician miscommunication contributes to approximately one-third of serious inpatient medical errors, resulting in an estimated 250 000 preventable deaths annually in US hospitals.  Handoffs during transitions of care represent a significant proportion of inter-clinician communication and are particularly susceptible to error. The Joint Commission and the Accreditation Council for Graduate Medical Education have identified handoff communication as a key target for national quality improvement and patient safety efforts.

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The Impact of Zero Interfaces on Clinicians

As part of the HITECH act, the federal government spent over $35 billion to incentivize the adoption of electronic health records (EHR).

Unfortunately, HITECH failed to mandate that these EHRs interoperate with other technologies. The result: 98% of all eligible hospitals have now demonstrated meaningful use of certified health IT, but health information is rarely exchanged without clinicians having to sign out of one system and into another.  

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Must Reads
Solving insulin dosing errors: A common detriment to hospital care quality

40% of patients experience an insulin dosing error during their hospital stay, according to the 2017 National Diabetes Inpatient Audit.  This constitutes a significant patient safety issue. Insulin can cause harm when used in error, and the Institute for Safe Medication Practices (ISMP) has classified all forms of insulin (subcutaneous and IV) as high-alert medications.

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Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the Intensive Care Unit

Key Points

Question  Does the UW-IPASS standardized handoff affect clinician communication in the intensive care unit?

Findings  In this single-institution cluster randomized stepped-wedge clinical trial, the use of a standardized handoff curriculum resulted in a significant 3% decrease in communication errors, without any change in the duration of the handoff. Seventy-three percent of clinicians reported that participation in the curriculum improved team communication and patient safety.

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Safety of Using a Computerized Rounding and Sign-Out System to Reduce Resident Duty Hours

Purpose. To determine whether changing sign-out practices and decreasing the time spent in rounding and recopying patient data affect patient safety. Responding to limited resident duty hours, the University of Washington launched a computerized rounding and sign-out system (“UW Cores”). The system shortened duty hours by facilitating signout, decreasing rounding time, and sharply reducing the time spent in prerounds data recopying.

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A Randomized, Controlled Trial Evaluating the Impact of a Computerized Rounding and Sign- Out System on Continuity of Care and Resident Work Hours

Background. Adoption of limits on resident work hours prompted us to develop a centralized, Web-based computerized rounding and sign-out system (UWCores) that securely stores sign-out information; automatically downloads patient data (vital signs, laboratories); and prints them to rounding, sign-out, and progress note templates. We tested the hypothesis that this tool would positively impact continuity of care and resident workflow by improving team communication involving patient handovers and streamlining inefficiencies, such as hand-copying patient data during work before rounds (“prerounds”).

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Organizing the transfer of patient care information: The development of a computerized resident sign-out system

Background. The problem of safe and efficient transfer of care has increased over the years as new and complex diagnostic tools and more complex treatment options became available. Traditionally, residents ensured continuity of care by working long hours and minimizing the transfer of significant diagnostic or therapeutic responsibilities to other providers. The new 80-hour workweek has curtailed that practice and increased the pressure on trainees for workflow efficiency. We report on a study of informationhandling routines among residents for the separate tasks of transfer of care (‘‘sign-out’’) and daily patient care work (ward work). Using these results, an institution-wide computerized system was developed to centralize information-handling tasks and facilitate the management and transfer of patient care information.

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