All Entries Tagged With: "handoffs"
Patient hand offs more about skills than checklists
As I continue to research patient hand offs for an upcoming article in Hospitalist Leadership Advisor, I’ve realized that hand offs are less about forms, tools, and checklists and more about having good communication skills.
I know I’m guilty of assuming that other people can read my mind from time to time—we all are. I recall asking my husband if we could go to the curtain store one day to pick out some shades for the dining room. We were on the highway for quite some time before he asked, “Where’s the curtain store?” Of course! I know where it is because I’m a home deco diva, but he had never been there before. I assumed that because I knew, he knew, and I probably would have been mad when he blew by the exit. Sounds trivial, but when it comes to patient care and physician relationships, these details are critical.
Here are three tips that I’ve picked up from my sources that will not only help practicing hospitalists improve the quality of patient hand offs, but also help leaders brush up their every day communication skills.
Explain your rationale: When handing patients off to another hospitalist, explain what symptoms prompted you to order certain tests, and be sure to tell the hospitalist taking over the care of your patient exactly what they need to look for when the test results come back. Don’t just say “Order texts X, Y, Z.”
Repeat back information: To ensure that your understanding of an issue matches the other person’s intended meaning, repeat back what they’ve said to you. You do this with driving directions, right? (So, I’m taking a left on to Mason St. and a right at the blinking red light.) So why not incorporate this strategy into your clinical work or leadership activities? “Repeat-backs have not only been shown to improve patient safety and prevent errors, but they also enhance memory,” says Vineet Arora, MD, MAPP, Assistant Professor of Medicine, Associate Director Internal Medicine Residency, and Assistant Dean Scholarship & Discovery at the Pritzker School of Medicine, University of Chicago.
Don’t assume a note will suffice: If you’ve ever left a note for a family member to pick up milk, you’ve probably been disappointed. That person either never got the note or didn’t know whether you wanted skim, 2%, or whole. “You are able to communicate better, richer information more effectively through the verbal communication channel than any other communication channel,” says Arpana Vidyarthi, MD, Director of Quality and Safety in the Division of Hospital Medicine, Director of Patient Safety and Quality Programs GME, Director of the Institute for Physician Leadership, and Associate Professor of Clinical Medicine at the University of California, San Francisco.
For more tips and advice for improving patient hand offs, look for your January issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing.
New handoff guidelines from SHM
I’m writing a case study for the September issue of Hospitalist Leadership Advisor (supplemental newsletter to Medical Staff Briefing) on a hospital that has developed a hybrid scheduling model. Basically, physicians spend one week on hospitalist duty and three weeks practicing in their outpatient offices. Naturally, I asked about patient handoffs—I figure if you’re not going to be back for three weeks, you should have a darn good system in place. And they do—hand-written notes are not allowed (electronic documentation only, thank you), and physicians discuss patient handoffs either face to face or over the phone so that there are no hanging questions. To boot, every Monday morning starts with a case conference.
Happenstance, I later ran into the Society of Hospital Medicine’s new recommendations for patient handoffs in the July issue of ACP Hospitalist. How many of these can you check off?
Hospitalists should:
Patient handoff training useful for interns, new study says
A new study from the University of Colorado School of Medicine, indicates that formal patient handoff training can help first-year interns at a teaching hospital. The handoff training helped boost interns’ perception of how much they knew about transferring the care of patients to other caregivers, according to the study, “A Structured Handoff Program for Interns,” published in the March issue of Academic Medicine.
Remember important communication details in your sign-out note
Establishing protocols and policies of communication is the most effective approach to managing communication among all caregivers, including hospitalists, PCPs, nursing staff members, case managers, social services, therapists, dietitians, and pharmacists.
This information exchange occurs at morning and nighttime checkout and via daily progress notes. An off-service note should be generated at the time a new hospitalist attending physician assumes care of the patient. The off-service note typically includes a “SOAP” (Subjective, Objective, Assessment, Plan) note, and more detailed information such as: [more]
Tips for effective surgical handoffs
As residents complete their 80-hour limit for the week, more doctors are changing shifts and leaving patients more vulnerable to handoff dangers. The Wall Street Journal Health Blog posted tips for surgical sign-outs between doctors, based on “The Top 10 List for a Safe and Effective Sign-out” in the October issue of Archives of Surgery. Some handoff suggestions include the following:
- Allocate time for doctors to sign out and doctors to sign in
- List important details, including patient’s surgery date and type, post-operative complications, pain management, and medications
- Design a plan to transfer patients to higher level care when necessary
- Contact the senior resident on call
- Describe the history and purpose of admission of patients to the on-call resident
