Some Patients May Be Shortchanged During Hospital Shift Changes
Doctors spent more time discussing patients based on room location, not case severity, study found
Wednesday, November 14, 2012
These brief but important discussions can have a major impact on patient care in the early parts of a shift. Research has shown that miscommunication during these handoff conversations is a major contributing factor in preventable medical errors, according to the study authors.
The researchers analyzed 23 shift handoff sessions involving 262 patients at a Canadian hospital and found that doctors spend too much time talking about the first cases on their list and then rush those at the end of their list, even though those last cases might merit a longer discussion.
The doctors turned over between six and 23 patients in each of the shift handoff sessions and spent an average of 2.5 minutes per patient, but that varied widely. Doctors typically spent at least 50 percent longer discussing the first patient on the list than the last.
The average time spent discussing each patient declined steadily as the doctors moved down their lists, which were ordered by room number, according to the study published online Nov. 12 in the journal Archives of Internal Medicine.
Instead of using lists based on things such as patients' names or room and bed numbers, doctors and nurses should give priority to the patients that require the most discussion, the researchers suggested.
"I would expect that people could shift to talking about the sickest patients first, or the most unfamiliar or complex case," study lead author Michael Cohen, professor of complex systems, public policy and information at the University of Michigan, said in a university news release. "There isn't a one-size-fits-all remedy except to say the person handing off should begin by making a judgment of which patients need the most time."
More than half a billion shift-change handoffs occur in U.S. hospitals each year, the researchers noted.
Handoff conversations have been identified as an important issue in previous research on patient safety problems in hospitals, but training on how to conduct proper handoffs has only recently begun to be offered to health workers. However, these best practices focus on how to hand over one patient, not a group of them, Cohen noted.
Since most handoffs involve multiple patients, the training should reflect that reality, Cohen said. Doing so could lead to improved patient safety.
"Hundreds of millions of handoffs happen in U.S. hospitals every year," Cohen said. "Just an increase of one-tenth of 1 percent in their effectiveness could translate into a large number of prevented injuries and lives saved."
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