In this final paper, I would like to summarize all the previous information about handoff process. First of all, it is necessary to remind the definition of handoff. “Handoff - is the transfer of patient care from one health care provider to another or from one health care facility to another” (Medical dictionary, 2009). There are many kinds of patient handoffs, including: “ physicians transferring responsibility for a patient;
physicians transferring on-call responsibility;
nursing shift changes;
temporary responsibility for staff leaving the unit for a short time;
anesthesiologist report to recovery room nurse,
nursing and physician handoff from the emergency department to inpatient units;
other hospitals, nursing homes, and home healthcare;
critical laboratory and radiology results sent to physician offices” (Patton, 2007).
This is very important process during patient’s medical care provision but, unfortunately, there have been no changes in this process for a long time. Many medical staff consider this process as easy and unimportant and as a result, the problem of inefficient handoff process arise.
Clinical staff handoff communication during shift change is an important part of the patient care process. Lack of effective staff communication in the career is causing problems since it has led to poor planning in various health institutions in the nation, especially in the ER rooms. What we have now, is a great amount of patients who are not satisfied with the medical service and handoff in particular. Moreover, the amount of medical mistakes that lead to bad consequences is unacceptably high. One example clearly demonstrates the situation in this field. According to the Centers for Disease Control, in 2010, there were 130 million visitors in emerging rooms what is 34% more with the comparison of 97 million in 1995. “Meanwhile, the number of emergency departments is down about 11% over that same time period” (Marte, 2013). It means, that the inverse proportion exists between the number of patients and the amount of ER rooms available: the more patients – the less rooms. It is not a surprise now, that because of that fact, the quality of medical care is suffering. Here is one of the problem of handoff process – a lack of ER rooms. In its turn, this leads to the increase of crowds and waiting time. The average waited time to see a physician is 37 minutes. “Even worse, those who were supposed to be seen in less than 1 minute were left waiting for about 28 minutes” (Marte, 2013).
The problem of the lack of ER rooms is to be sold as soon as possible with the help of the government. Legal stimulations can be implemented in order to promote the appearance of new health facilities and the support for already existing. One more way out is to implement a pay-for-performance system for hospitals. This system was created by the Affordable Care Act. According to this system, “Medicare payments to hospitals are partly based on patient satisfaction” (Marte, 2013). With the adoption of this system, hospitals are interested in patients’ satisfaction and will do their best to make patients happy. This will also relate to the handoff process because matter how good is the handoff process established depends the first impression of whole hospital.
What is even more serious problem is the poor communication in ER rooms. This problem have many aspects:
Unqualified medical personnel;
Lack of coordination between hospital staff;
Lack of attention to a patient.
Unfortunately, the problem of the quality of personnel is very vital not only for commercial companies but also for medical sphere. The role of nurses is very important during the handoff process because they are the first who communicate with patients. That is why, a good qualification for nurses is as important as for doctors. The efficient coordination between hospital staff is an indispensable part of a successful hospital functioning. Very often, in ER rooms there is no much time and every step must be taken quickly, consciously and competently. Joint Commission International Center for Patient Safety has developed several strategies to improve handoff communication:
“Use clear language and avoid use of abbreviations or terms that can be misinterpreted” (Joint Com., 2005). All the prescriptions and information about patients should be clear and precise.
“Use effective communication techniques. Limit interruptions. Implement and utilize read-backs or check-back techniques” (Joint Com., 2005). Nurses and doctors should understand each other and facilitate work of each other but not to complicate it.
“Standardize reporting shift-to-shift and unit-to-unit” (Joint Com., 2005).
“Assure smooth handoffs between settings” (Joint Com., 2005).
“Use technology to enhance communication. Electronic records can support the timely and efficient transmission of patient information” (Joint Com., 2005).
All these strategies have a short-term goal– to improve handoff communication and make patient safe. A long-term goal is to “create a standardized approach to hand-off communications, including an opportunity to ask and respond to questions” (Joint Com., 2005). In 2006, the Joint Commission added transitions in patient care to its national Patient Safety Goals. Since that time, the importance of the issue is officially recognized.
In 2013 in Baltimore took place Maryland Patient Safety Foundation’s 9th Annual Patient Safety Conference. On this conference Safer Sign Out process was presented. Safer Sign Out is a method for formalizing the patient sign out for ED physicians. Three main tools of this process were named:
Patient handoff checklist – “note patient diagnoses, key issues, potential safety concerns and pending items;
“Physicians go together to the bedside to meet with patients about the plan of care;
“To relay that plan to nurses and other members of the care team” (O’ Reilly, 2013).
These statements may seem very easy and evident. The official acknowledgment of its importance will lead to its 100% implementation.
The American College of Emergence Physicians pointed out the key steps in strengthening the handoff process:
“Record - specifically and clearly record to identify the critical items that pertain to the patient as well as which items are pending.
Review - provides an interactive opportunity to assure there is a "shared understanding" of what has been done and what is still needed.
Round - Briefly seeing the patient together
Relay to the Nurse/Team - communicate the transition and exchange information with the responsible nurse/team members.
Receive Feedback - The sign out form allows the on-coming physician to record the outcome of the sign out and to provide the off going physician the result in a reliable and asynchronous manner” (Am., Coll., 2014).
One more official document that arise the problem of handoff process is Healthy People 2020. This document of decease prevention and health promotion has one of its goal: to improve health communicative strategies.
Poor communication in health care may cause next problems:
Diagnostic Accuracy. A thorough and detailed questioning of patients will help to prevent medical staff from medical error. A correct diagnose a half way to patients’ recovery.
Adherence. Many patients do not comply with doctor's advice and prefer not to take all the prescribed medicine. That situation may occur because doctors neither endear their patients nor command their respect.
Patient satisfaction. When a patient do not fill any respect or care about himself he usually do not satisfied with a medical services.
Patient safety. “When health care team members do not communicate effectively, patient care often suffers” (Patton, 2007).
Malpractice Risk. According to O’Reilly research, “71% of the malpractice claims were initiated as a result of a physician-patient relationship problem” (O’Reilly,2013).
References
Medical Dictionary (2009). Handoff. Retrieved from http://medical-dictionary.thefreedictionary.com/handoff
Marte, J. ( 2013, 10 December). 10 things emergency rooms won’t tell you. Market Watch. Retrieved from http://www.marketwatch.com/story/10-things-emergency-rooms-wont-tell-you-2013-12-06
Patton, K.A. (2007). Handoff Communication: Safe Transitions in Patient Care. Global Edition. Retrieved from http://www.usahealthsystem.com/workfiles/com_docs/gme/2011%20Workfiles/Handoff%20Communication-Safe%20Transitions%20in%20Patient%20Care.pdf
Joint Commission International Center for Patient Safety (2005). Strategies To Improve Hand -Off Communication: Implementing a Process to Resolve Questions. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2649/table/ch34.t2/?report=objectonly
O’Reilly, K.B. (2013, April 17). Emergency doctors promote patient handoff checklist. American Medical News. Retrieved from http://www.amednews.com/article/20130417/profession/130419988/8/?utm_source=rss&utm_medium=&utm_campaign=20130415&utm_source=rss&utm_medium=rss&utm_campaign=emergency-doctors-promote-patient-handoff-checklist
American College of Emergency Physicians (2014). Safer Sign Out Protocol. Retrieved from https://www.acep.org/content.aspx?id=88004
