Patients in health care facilities commonly receive care and treatment from a team of medical professionals, rather than an individual. This is true at many small practices, but becomes increasingly prevalent as the size of the care facility increases or the severity of a condition worsens. When patients are transferred, or handed-off, between different medical professionals there is a risk that communication failures can negatively affect the quality of care provided.
In this article, the health care experts discuss patient hand-off communication within organizational facilities such as hospitals and long term care/rehabilitative settings.
Patient Hand-Off Communication - Expert Article
What is Patient Hand-Off?
Patient hand-off is the process of transitioning a patient to medical personnel within a facility or to a different facility. This written and verbal communication is imperative to patient safety and creates an ongoing record that alerts relevant staff to a patient’s care, treatments, condition, and any recent or anticipated changes.
How frequently and why do Hand-Offs Occur?
The average length of a hospital stay is 4-5 days, stays at short term rehabilitation settings average about 20 days, and the average length of stay in nursing homes prior to death is 14 months. During any prolonged stay, patients will come into contact with various providers and caregivers. Nurses change shifts every 8 or 12 hours, depending on the type of institution, and there are often multiple physicians and members of the interdisciplinary team involved in patient/resident care. If a patient’s condition stabilizes, they may be moved to an acute rehabilitation or long term care facility for additional care, introducing a new set of providers and caregivers.
Depending on the patient’s treatment plan and length of stay, they will be handed-off between nurses, members of the interdisciplinary care team, and other facilities when necessary. As patients transition between care providers and facilities, the quality and success of ongoing care relies upon, among other things, quality hand-off communication.
How Can Hand-Offs Lead to Negative Outcomes or Adverse Events?
Quality medical care often requires a continuum of services within and between medical facilities. If the hand-off fails to adequately relay accurate, timely, and complete information to the receiving professional, the patient faces an increased risk for inappropriate or incomplete care. Patients with allergies, certain pre-existing conditions, or dire prognoses are potentially more susceptible to harm caused by shortcomings in hand-off communications.
What does Appropriate Hand-off Look Like?
Proper patient hand-off requires a combination of verbal and written communication. Standards require that organizations adopt a process that “provides for the opportunity for discussion between the giver and receiver of patient information.” This discussion may include information regarding a patient’s condition, treatment, care plan, and medications. It also allows for the opportunity to discuss any current or anticipated changes that may occur while caring for the patient.
Care providers also rely on the written clinical record as a means to gather data and communicate a patient’s status within the interdisciplinary care team. It is a means for all personnel, even those not present during a transition, to know exactly what/how and why a medical intervention was or was not provided. This written record may be used before, during, and after the verbal hand-off communication to obtain additional data regarding the patient’s condition, treatments, care plan, and medications. This documentation should provide a concise picture of the patient’s progress, including response to treatment, change in condition, and changes in treatment, thus informing the dynamic development of their care plan.
There are several strategies used across the health care industry for effective patient hand-off communications. These are facility dependent and may include, among others:
- Standardizing the content provided in a hand-off communication to include the information necessary to safely care for the patient.
- Providing/creating an environment that will allow hand-off communications to be completed with minimal interruptions and distractions.
- Conducting a face-to-face hand-off that includes the patient and family.
- Developing effective policies and procedures specific to hand-off communication.
- Developing a system where both verbal and written hand-off communications are performed.
There is not a single foolproof method, but rather a combination of practices that when performed in consideration of the needs of the facility, will assist in creating a safe and effective patient hand-off process.
What Standards Exist for Hand-off Communication?
In 2010, The Joint Commission established a standard for hand-off communication titled, Provision of Care Standard PC.02.02.01. This provision describes procedural requirements for organizations to receive or share patient information when the patient is referred to other internal or external providers of care, treatment, and services.
Patient Hand-off Incident Investigations
The Health Care practice group at Robson Forensic includes registered nurses, nursing home administrators, nursing directors, wound care specialists, corporate compliance officers and physical therapists who can determine if an error or break in communication during patient hand-off occurred and if/ how that failure affected the health, safety and welfare of the individual patient/resident. These investigations may include, among other things, analysis of the facility’s patient hand-off procedures, and whether a failure to communicate between and among personnel affected the patient’s outcome.
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