From One Nurse to Another – Better Handoffs are Long Overdue

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Patient handoff

It’s no secret handoffs are dangerous. It’s impossible for the same nurse or doctor to remain with a patient around the clock, and handing care from one professional to another is a must. But the very nature of handoffs makes them dangerous.

Busy providers mean that communication can be poor, and information incomplete. Medical professionals know that shifting the responsibility of care from one person to another is risky, and so do patients.

Patient trust and satisfaction is hindered by handoffs.  Studies show patients are stressed providers aren’t doing the best job at thoroughly communicating with the next in line. And they’re right to be worried – handoffs have consistently been cited as detrimental to patient outcomes, and are documented causes of malpractice lawsuits. The most vulnerable patients are the ones whose conditions are the most critical, such those in the ICU.

The problem has been worsened, too, by the recent increase in physicians who only work in the hospital setting, with no prior relationship to the patients they are treating. And, regulations on the number of hours a provider can work changed in 2003, so the number of transitions between providers has also increased for the average patient.

Recent developments in standardization

In the last decade, standardized methodologies for patient handoffs have emerged, mainly as a result of a change in law that now requires hospitals to have a documented handoff approach.

Facilities use a number of standard methodologies in handoffs, each seeking to make sure providers don’t skip on documenting and sharing important patient info. All of these approaches have key things in common – including basic patient details and who the care team is, diagnoses and treatment plans, and what issues to anticipate.

They also have mnemonics like “IMOUTA” and “I PASS the BATON” to help professionals remember them on the floor, and to use them like checklists. To help promote better, standardized handoff procedures, professional organizations like the American College of Obstetricians and Gynecologists and the American Association of Neurological Surgeons have also published their own recommendations for following standard handoff procedures.

Technology leads improvements

But beyond checklists, technology is improving patient handoffs by collecting the right information and standardizing procedures. New applications and software are helping to fill common gaps in communication.

Nobody can remember every single thing they’re told, and the new technology allows those details to be stored and communicated easily. The information providers need about a patient can vary by facility, department, and specialty, so many also offer customization to make sure what’s transmitted is what’s most useful in that case.

Because patient information can often be split between different departments, some of these apps will pull all the data together in one unified spot. One of the biggest improvements these technologies offer is time – they can streamline and organize tasks, leading to more time for the important conversations to happen between providers.

Here are some apps you might see:

  • Zoeticx
  • e-Handoff
  • Smart Sign Out

Use with caution

But the new technologies are not a cure-all of the problems handoffs create. It’s important for any provider using these new technologies to prioritize face-to-face conversation.

The new systems are meant to supplement, but not replace, interaction between providers. Also, not all information is right for the new technologies. Handoff notes are different from permanent medical records, and what’s included in handoff notes might not be appropriate for permanent records or files.

Future improvements

And there’s still much to be done to improve handoffs overall.  One place many are focusing on is medical education. Proper handoffs start when a nurse or physician is in school. Recent studies show that not all medical and nursing students are taught handoff procedures, and of those who are, many do not receive related guidance until their fourth year. Most undergraduates studying medicine receive no handoff instruction.

Most nursing schools also do not provide systematic handoff education. But this is changing – and the more health care professionals incorporate thorough handoffs from the beginning of their careers, along with increased systematic approaches by care systems, handoff outcomes will continue to improve.

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