handoff communication
Handoff communication occurs when a patient is transitioned from one care setting to another. Communication is central to handoffs, and clinical staff are expected to share comprehensive details about the patient’s health to the next care provider in charge.
During handoff, sensitive information is passed in real time to another care provider during changes in shift or care setting. This equips the next care personnel with contextual information about the patient’s health, empowering them to provide the best course of care under their supervision.
However, human interactions can act as a single point of failure (SPOF), and they introduce vulnerability to clinical processes and the patient’s wellbeing. Information that’s inaccurate, incomplete, not timely, or misinterpreted can cause severe harm to the patient. Per the Joint Commission, an estimated 80 percent of all serious medical injuries in hospitals are tied to communication during handoff.
In this blog, we’ll investigate the topic of handoff communication and share best practices to alleviate the risks around this topic.
Patients are assigned to several specialists on a care team, giving rise to discontinuity in care delivery in healthcare. Discontinuity creates opportunity for errors when patient information is not accurately transferred across care teams. Well-executed handoff communication alleviates risks associated with discontinuous care delivery and augments decision-making.
Clinical teams take immense care and diligence in meeting patient needs and delivering the best possible treatment for those that need it. Handoff communication is a key element of the patient care continuum and its efficacy drives care continuity and patient safety.
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We will now take a look at a few handoff scenarios between care providers and explore best practices to mitigate discrepancies in communication and misalignment in expectations.
Handoff Exchange Between Two Nurses: Charge Nurse Stephanie from the inpatient room is receiving a patient from the emergency unit. Nurse Myra is in charge of the emergency unit and is facilitating the transfer. The patient’s medical administration record (MAR) and handoff note has been updated with all the required information, including that the patient was just given a dose of morphine sulfate painkiller. Stephanie receives the patient and considers administering pain medication based on the patient’s symptoms. She was able to prevent an accidental overdose after she referred to her handoff notes.
Handoff Exchange Between a Nurse and Lab Technician: Nurse Carla Espinosa gets on a call with Lab Technician Tim Cardashian to gather lab results for her patient. Handoffs that are taking place over a phone call must include a read back. This means the information recipient must make notes of the details being received and read them aloud for the caller to acknowledge. This information-verification process eliminates the chance of miscommunication errors.
Advanced handoff tools allow clinical teams to securely exchange patient information to deliver care continuity and reduce adverse events.
While there are many tools available, some are more relevant in certain scenarios than others. Below is a representative scenario using the abbreviated strategy tool known as PASSONS.
| PASSONS Patient Handoff Example | |
| Patient Information | Patient Mrs. Smith, a 78-year-old woman, is experiencing shortness of breath associated with a productive cough. She also has been experiencing mucus production for four days with a temperature of 101 degrees Fahrenheit and a fast heart rate. On arrival, she was desaturating to 85 percent on six liters of oxygen. She has chronic obstructive pulmonary disease (COPD), hypertension and hyperlipidemia. At home, she requires two liters of oxygen at baseline. |
| Active Hospital Course | Mrs. Smith significantly required more oxygen when she arrived at the hospital, and clinicians have been treating her with azithromycin. As for COPD exacerbation, clinicians have been giving her treatment X and treatment Y. |
| Status (Code status and patient status) | Mrs. Smith appears to be doing well with the administered medication. She is also on two liters of oxygen, which is her home requirement. On arrival, she was critically ill but now is stable with a full code status. |
| Supporting Data | Clinicians did a chest X-ray and showed an infiltrate. Clinicians also examined Mrs. Smith’s mucus production issues and diagnosed her with pneumonia. |
| Overnight To-Do | There is nothing to follow up on overnight. If Mrs. Smith does desaturate, she is doing well with X treatment. |
| Nursing (Pain plan, diet status and procedures) | Mrs. Smith has a regular diet, and if she needs anything for pain, it is okay to give her acetaminophen for occasional headaches. |
| Summary by receiver | Mrs. Smith arrived at the hospital with a shortness of breath and was diagnosed with a COPD exacerbation. Practitioners diagnosed her with pneumonia and was treated with antibiotics and steroids. Mrs. Smith is now back to baseline. |
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There are many ways in which patient handoff can be enhanced – deploying technology, establishing guidelines and templates, encouraging collaboration and more. These processes facilitate a stress-free handoff experience and enable safe care delivery.
Establish Guidelines and Templates
Relying on memory to carry out crucial healthcare transitions is not an effective strategy. Hospitals must establish checklists and frameworks that can be easily followed in different handoff scenarios.
Interactive, Interdisciplinary Handoffs
Collaborative handoffs deliver a comprehensive information exchange between providers. This includes updated information on patient care, treatments, conditions, reactions to medications and any recent changes. That way, care teams can maximize their collective knowledge and improve clinical decision-making.
Clinical Communication and Collaboration Solutions
A clinical communication and collaboration (CC&C) platform drives best practices in handoff communication. These advanced, digital communication systems allow practitioners to exchange sensitive patient information via a secure, encrypted mobile channel.
CC&C systems can integrate with electronic health record (EHR) solutions and facilitate patient handoffs across the care continuum. With the integration, contextual alerts are sent to care teams, so that when a time-sensitive event, such as a STAT order or a lab-result is detected on the system, the care team is instantly notified on mobile.
Handoff communication is a key component in driving continuity of care in today’s healthcare system. Healthcare CIOs must consider implementing tools and frameworks discussed in this article to foster a fail-safe handoff process, eliminate miscommunication and provide a safe patient environment.
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