During the shift change, a range of risks for a patient occurs caused by poor communication between the doctors and nurses from the two shifts. Improvement of this communication would help with the continuity of care after individual patients during such changes. Improved communication in an interdisciplinary team would promote patient safety. The given paper refers to the tools and guidelines regulating the patient handoff as well as to the communication failures that lead to medical errors. Proper strategies and tools applied during the shift change can prevent patient deaths and increase the quality of medical services.
Handoff as a Cause of Medical Errors
A large number of problems occur due to the lack of communication during the change shift. According to Streeter and Harrington (2017), 65% of medical errors occur due to communication problems, and half of these cases take place during handoff. Other sources claim that almost 80% of errors take place during the patient handoff (Streeter & Harrington, 2017). This is a striking statistic, considering that medical errors are the third highest cause of death in the United States (Streeter & Harrington, 2017). This is the reason why it is important to increase the quality of communication between medical professionals from different shifts.
Handoffs are defined as the exchange of information about a patient between medical professionals accompanied by the transfer of control and responsibility of the patient. Handoff methods can be written, face-to-face, recorded, and bedside (Streeter & Hamilton, 2017). Electronic patient records and other tools based on modern technologies can also be useful during handoff, and they are becoming more widespread. Apart from the instrumental base, nursing professionals should also have effective communicative strategies to meet complex challenges.
There are different reasons due to which handoff miscommunication can occur. For example, it can be unsupportive organizational culture, lack of time, unaligned expectations, ineffective methods of communication, unstandardized procedures, and out-of-sync timing (Streeter & Hamilton, 2017). Besides, usage of jargon or confusing language, as well as forgetting information or losing it, can also be the reason for miscommunication. Finally, providing too little, inconsistent, or inaccurate information can lead to the one-way transfer instead of an exchange, which also leads to a number of problems. The form of reports is also important, as too lengthy report process can take long time and be neglected.
Guidelines and Tools Regulating Patient Handoff
TJC is a guideline that regulates the process of shift changing and patient handoff. However, they have a general nature, while the specific details of handoff procedure are defined by a particular organization. TJC includes standardized checklists, such as Situation-Background-Recommendation one (SBAR), which helps the professionals to collect the key information concerning the patient and to organize it. TJC can reduce the number of medical errors that occur during shift change.
The PACE Tool
The PACE Nurse Handoff Tool, a communication-based guide, can also be used for increasing the efficiency of handoff. It is based on four principles, the first of which demands presenting relevant and appropriate information to the next shift. The second principle is asking questions concerning the patient. The third principle is checking and clarifying the information in complex cases. According to the fourth principle, all concerns, respect, and appreciation should be expressed.
A control chart could serve as a tool for analyzing the number of medical errors associated with the handoff. It could include qualitative measurements and data, such as the fact of following or not following specific tools and regulations. Besides, it could include quantitative data concerning the number of deaths or medical errors that occur in the groups that have used these tools and that did not use them. The feedback from the nurses is also very important, as they can form the best and the worst handoff cases in order to create a sample of an ideal handoff algorithm.
Six Domains of Health Care Quality
There are six domains of health care quality, defined by the Institute of Medicine. The Agency of Healthcare Research and Quality (2021) lists the following domains: safety, effectiveness, timeliness, efficiency, equitableness, and patient-centeredness. First of all, medical professionals should avoid actions that are harmful to patients. Second, all the operations should be based on scientific knowledge and be beneficial for the patient, while non-beneficial actions should be avoided. Third, the medical professional’s actions should correspond to the patient’s individual needs, values, and preferences. The actions should be made without any delays, in a timely manner. Besides, all the actions and operations should be precise, avoiding the waste of time, equipment, energy, and other resources. Finally, the care should be equitable and provided with the same quality regardless of gender, ethnicity, socioeconomic status, and geographic location. All the medical procedures should correspond to these demands. However, the errors occurring during the patient handoff show that there are problems in some of the domains during the shift change. It seems that most handoff-related errors are associated with the domains of patient-centeredness, as the information concerning the patient’s individual needs is neglected and is not communicated in a precise manner during the handoff failures.
The Worst and the Best Handoff Cases
The worst cases of handoffs were characterized by nursing professionals as the ones that do not allow to prepare to the patient care. According to the research made by Streeter and Hamilton (2017), in some cases, the incoming nurses “did not pay attention” or “did not listen” the information concerning the patient provided by the outgoing nurses. They explained it, saying that they can get all the necessary information from the chart. Sometimes the outgoing nurses did not allow to ask any questions and were annoyed by such attempts. They did not provide the necessary information concerning the patient’s state, which made the tasks of the incoming nurses more difficult. The best handoff cases were characterized by the two-side information exchange, asking questions, and information verification.
Donabedian’s Model Applied to the Patient Handoff
The model suggested by Avedis Donabedian can be used for the estimation of the medical process. According to this model, it can be evaluated based on three components: structure, process, and outcomes (Ayanian & Markel, 2016). In case of patient’s handoff, the structure would include the capacity of the medical professionals to provide an efficient handoff which would respond to the needs of the patient. The process would include the usage of communication strategies, clarification of the information, asking questions, and following the relevant guidelines and tools. The successful outcomes would be associated with timely and precise communicating of the information necessary for the handoff.
Plan, Do, Study, and Act Cycle
In terms of the Plan, Do Study, and Act Cycle, it is possible to set a goal that would increase the quality of patient handoffs. For example, a goal can include checking whether the proper questions are asked and answered by the nurses and whether the guidelines are followed. The statistics of the medical errors during the handoffs can reflect the success of the strategies applied. Besides, the checklists or reports can be applied containing the information concerning the given patient. The communication strategies and the overall openness and willingness to provide the necessary information should be evaluated. Finally, the changes in the nursing professionals’ behavior should be done based on the analysis of the success of their communication during the shift change.
Agency for Healthcare Research and Quality (2021). Six domains of health care quality.
Ayanian, J. Z., & Markel, H. (2016). Donabedian’s lasting framework for health care quality. New England Journal of Medicine, 375(3), 205–207. Web.
Streeter, A. R., & Harrington, N. G. (2017). Nurse handoff communication. Seminars in Oncology Nursing, 33(5), 536–543.