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Docs Report Patient Safety Often at Risk in ER to Inpatient Handoff

Posted on Sat, Aug 01, 2015
Docs Report Patient Safety Often at Risk in ER to Inpatient Handoff

Both ER, inpatient physicians say patient safety is at risk during handoff

THURSDAY, July 30, 2015 (HealthDay News) -- Physicians report that patient safety is often at risk during the emergency department admission handoff process due to ineffective communication. The findings were published online July 22 in the Journal of Hospital Medicine.

Christopher J. Smith, M.D., from the University of Nebraska Medical Center College of Medicine in Omaha, and colleagues surveyed resident, fellow, and faculty physicians directly involved in admission handoffs from emergency medicine and five medical admitting services at a 627-bed tertiary care academic medical center.

Based on responses from 94 admitting and 32 emergency medicine physicians, the researchers found that admitting physicians reported that vital clinical information was communicated less frequently for all content areas (P < 0.001), compared to emergency medicine physicians. Nearly all (94 percent) of emergency medicine physicians felt defensive at least "sometimes." Just under one-third of all respondents (29 percent) reported handoff-related adverse events, most frequently related to ineffective communication. Sequential handoffs were commonly reported for both emergency medicine and admitting services, and 78 percent of physicians reported that these handoffs negatively impact patient care.

"We identified several perceived barriers to safe inter-unit handoff from the emergency department to the inpatient setting. Handoff-related adverse events, a pattern of conflicting physician perceptions, and frequent sequential handoffs were of particular concern," the authors write. "Our findings support the need for collaborative efforts to improve interdisciplinary communication."

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Hospital Staff Say 'Crisis Mode' Obstructs Communication

Posted on Sun, Jan 04, 2015
Hospital Staff Say 'Crisis Mode' Obstructs Communication

Workers who perceive high stress at work think it interferes with exchange of patient information

WEDNESDAY, Dec. 17, 2014 (HealthDay News) -- Staff members who perceive a work climate of crisis mode in their hospital units say that it leads to problems in exchanging patient information, according to research published online Dec. 10 in the Journal of Hospital Medicine.

Mark E. Patterson, Ph.D., M.P.H., of the University of Missouri in Kansas City, and colleagues analyzed self-reported data from 247,140 hospital staff members across 884 hospitals. The authors sought to assess the association between perceived crisis mode work climate and problems with patient information exchange.

The researchers found that hospital staff members who agreed that the unit in which they work tries to do too much too quickly, compared with those who disagreed, were more likely to perceive problems with exchanging patient information across hospital units (odds ratio, 1.6; 95 percent confidence interval, 1.58 to 1.65).

"Because effective communication during handoffs is associated with decreases in medical errors and readmissions, hospitals need to continually ensure that work environments are conducive to effective patient information exchange," the authors write.

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Better Physician Communication at Shift Change Reduces Errors

Posted on Sun, Nov 09, 2014
Better Physician Communication at Shift Change Reduces Errors

Detailed 'handoff package' helps remind physicians about patient needs

FRIDAY, Nov. 7, 2014 (HealthDay News) -- Changing how doctors communicate during shift changes in hospitals reduces the risk of adverse events in patients by 30 percent, according to a study published in the Nov. 6 issue of the New England Journal of Medicine.

In a study of 10,740 patients, Amy Starmer, M.D., M.P.H., of the Harvard Medical School in Boston, and colleagues found that a better method of communication reduced the rate of medical errors by 23 percent and the rate of preventable adverse events by 30 percent. To improve communication between doctors caring for patients, Starmer's team instituted a "handoff" program at nine hospitals. The study authors measured how effective the program was in reducing medical errors and adverse events in patients. They also looked to see if the program interfered with workflow.

Specifically, they developed a method of communication dubbed the "I-PASS Handoff Bundle." For each patient in the doctor's charge, both oral and written data are required to describe: I; Illness severity (the patient's condition); P: Patient summary (what's wrong with the patient and history); A: Action list (what needs to be done); S: Situation awareness and contingency planning (planning for what might happen); S: Synthesis by receiver (asking questions, showing the material was understood).

Doctors were trained to use the system, as well as how to use it in conjunction with the electronic medical record system, Starmer told HealthDay. In addition to reducing medical errors, such as prescribing the wrong medications or procedures, the program didn't take a toll on the doctors' workflow. "We are really excited about the study," Starmer said. "Not only do we see a dramatic reduction in medical errors, but we found that this method is adaptable to other hospitals and to other health care workers, such as nurses and surgeons."

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