Safety/Quality of Care

Emergency physicians suggest ways to reduce errors in patient handoffs during shift changes

Emergency departments (EDs) are one of the most vulnerable areas in a hospital for high rates of patient care errors. There is a particularly high risk of medical errors when nurses and physicians come and go during shift changes and "hand off" patients. Recently, a group from the American College of Emergency Physicians interested in patient safety published insights into the patient handoff process and advice on how to improve safety during these transitions.

Errors can occur during one of four care transition stages: preturnover (current provider organizes and updates patient information), arrival (current provider stops patient care tasks and prepares to hand off care), meeting (outgoing and incoming providers meet face-to-face to exchange patient information), and postturnover (incoming provider integrates new information and begins caring for both patients handed off and newly arriving patients). The meeting stage can be fraught with potential errors. For example, the departing physician could pass along incomplete or incorrect information to the physician taking over. This individual can also misunderstand conveyed information or be distracted by shift change stressors.

The ED physicians' group offers a number of ways to make patient handoffs safer. One way is to reduce handoffs by completing discharges that are close to shift changes. Another approach is to have ED personnel provide succinct overviews of patients in a quiet, dedicated space to minimize distractions and interruptions. Lab and other study reports should be readily available for the receiving team to review. A cross-checking procedure is encouraged, where receiving physicians ask questions and engage in discussion of outstanding tasks yet to be done. All patients should be accounted for, even if they are in another department at the time of the shift change. Future research should concentrate on characterizing the high-risk handoff; defining the timing, location, and presentation order of handoffs; and identifying quality gaps in the process, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16640).

See "Improving handoffs in the emergency department," by Dickson S. Cheung, M.D., M.B.A., John J. Kelly, D.O., Christopher Beach, M.D., and others in the February 2010 Annals of Emergency Medicine 55(2), pp. 171-180.

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