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7 critical steps in improving clinical staff hand-offs
This week, the Joint Commission took aim at hand-off communication, the critical passing of key patient information that occurs when clinicians leave at the end of their shift and pass on responsibility for patient care to the next shift.
Communication failures were at least partly responsible for 30 percent of all malpractice claims, and resulted in 1,744 deaths and $1.7 billion in malpractice costs over five years, a 2015 study found. Widespread IT use has not solved the problem. The Joint Commission issued a Sentinel Event Alert to provide seven recommendations for hospitals and other healthcare settings to vastly improve hand-offs.
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Organization leaders must commit to improvement
Leaders are highly visible, and they must demonstrate action to improve systems that support hand-offs.
• Don’t just single out individual errors. • Provide support, time and budget to hand-off improvement initiatives.
Critical content must be standardized
Organizations should narrow down what needs to be communicated during transition times—both verbally and in written form, potentially through IT systems.
• Include everything needed to safely care for patients in a timely fashion. • Standardize tools and methods (forms, templates, checklists, protocols, etc.) • Avoid the exclusive use of electronic or paper communications; allow person-to-person interaction.
Settings should support direct, undistracted communication
Effective hand-offs require a consistent location and time for communication.
• Offer communication channels for those going off shift, and those coming on, to contact each other, perhaps by cell phone or text. • Involve patients and their families in the process, but don’t rely on them to communication vital information.
Staff need standardized training on hand-off best practices
Education must look at best practices for both the “sender” and “receiver” of patient information.
• Engage in practices that emphasize real-time observation and performance feedback. • Identify those who are good at hand-offs and can teach the skills. • Emphasize teamwork and staff commitment.
EHR capabilities, other technologies can assist hand-offs
Organizations must take full advantage of electronic health records system and supporting technologies—such as apps, patient portals and telehealth—to enhance hand-offs.
• Include standardized handoffs in workflows and incorporate it into the EHR. • Portals can provide backup by giving patients/families access to records, prescriptions, lab and diagnostic results.
Organizations should monitor results of hand-off interventions
Appropriate managers should be tasked with measuring the success of new procedures to improve hand-off communications, engaging analytics to assist them.
• Use lessons learned to drive further improvement. • Measure causes of poor hand-offs and eliminate them; collect data from across the organization to improve its systems.
The organization must sustain the improvement process
Executives can’t stop after early gains—the organization must spread best practices and make continued improvement a cultural priority.
• Drive toward consistent use of high-quality practices. • Implement systems to gather information and reinforce longitudinal monitoring.
For more information
The Joint Commission has more information and a downloadable copy of the alert here.