"Hand-offs" Among Healthcare Providers

A study of this age-old practice finds communication breakdowns.

Verbal "hand-offs" among healthcare providers have been necessary since the time when two or more healthcare providers cared for one patient. Even Florence Nightingale noted the need to discuss patients when a nurse came on duty and relieved another nurse. Through the years, various "hand-off" methods have been used, such as written reports from one person to the next, audiotaped verbal reports (which does not provide the opportunity to ask questions of one another), in-person verbal reports at a central location, and in-person verbal reports at the patient's bedside. Bedside reporting allows the patient to be a part of the "hand-off" process.

Not surprisingly, researchers at the University of Chicago studied "hand-off" communication among residents at the Comer Children's Hospital and found that the residents were confident about their "hand-off" communication; however, 60% of the time, they actually had breakdowns in communication. The most common communication breakdown was why a medication had been prescribed for a patient. Another breakdown that occurred frequently was contacting other physicians; while the oncoming resident knew that a physician needed to be contacted, the rationale was unclear. The researchers noted that the high rate of miscommunication is particularly alarming considering that the residents do hand-offs under optimal conditions (in a separate room designated for end-of-shift reporting) and under the supervision of their superiors.

Although the study involved residents in pediatrics, it's likely that the same results would be found in other areas of practice and with other groups who need to "hand-off" patients, such as emergency department staff and inpatient staff, inpatient staff and home care staff, and so on. Since hand-off communication is critical to patient care and safety, additional research needs to be conducted on how to best solve the problem. A study comparing the outcomes of different ways of communicating (eg, in person, taped, etc.) would provide helpful information about what might work best. This is yet another area ripe for nursing research.

Reference

Chang VY, Arora VM, Lev-Ari S, et al. Interns overestimate the effectiveness of their hand-off communication. Pediatrics 2010; 125:491-496.