Better Communication During Patient Handoffs Necessary, Study Says

A new study from Boston Children’s Hospital’s division of general pediatrics, which was published last week online in the Journal of the American Medical Association (JAMA), indicates that improved communication during patient handoffs can reduce medical errors.

Sounds simple enough. But medical errors are a leading cause of death and injury in the U.S., and according to Boston Children’s Hospital, an estimated 80 percent of serious medical errors involve some form of miscommunication, especially when care is transferred in a hospital setting from one provider to the next.

“By introducing more standardized communication during patient handoffs for this study, Boston Children’s saw a substantial drop in the overall number of medical errors,” says the study’s principal investigator Dr. Christopher Landrigan in a press release. “We believe if other medical centers adopted similar protocols it could have a positive and significant impact on patient safety.”

With the goal of improving provider-to-provider communication, Landrigan and Dr. Amy Starmer, lead author of the study, designed a new, multi-faceted handoff system that consists of three key components: standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure.

The researchers examined 1,255 patient admissions that occurred during the implementation of the handoff system to measure how it impacted patient care and clinician workflow across two separate inpatient units at Boston Children’s. According to the release, the error types included those with little or no potential for harm, intercepted potential adverse events, non-intercepted potential adverse events, and preventable adverse events.

Preventable adverse events decreased from 3.3 per 100 admissions to 1.5 per 100 admissions following intervention. “Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan, but though vital to patient care, rarely receive communication or handoff training,” Starmer says. “We sought to rectify that omission with this study.”

Participants adopted an easy-to-remember mnemonic to ensure all important information was verbally communicated properly during patient handoff. Face-to-face handoffs were restructured to involve all team members in order to minimize interruptions and distractions. And in conjunction with Boston Children’s informatics team, the researchers created an electronic handoff tool that self-populates with standard patient information. This replaces the previous method that required clinicians to manually enter and re-enter information in a word processing document, which can increase the potential for human error.

“We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude,” Starmer says in a press release. “And even more surprising was that the systems were introduced so easily. Participants embraced the new systems, became more productive, and could then focus more energy to the job at hand.”

After implementation of the communication bundle, of the 1,255 patient admissions studied, medical errors decreased 45.8 percent. In addition, care providers spent more time communicating face-to-face in quiet areas conducive to conversation, and spent more time bedside with patients.

Based on the results of this study, the team developed I-PASS, a handoff bundle rolling out to 10 teaching hospitals across North America. “Our ultimate goal,” Landrigan says, “is to develop a robust handoff program that can be broadly disseminated across hospitals and specialties to reduce medical errors and optimize patient safety.”