The Medical Hand-Off: When to Beware

The Medical Hand-Off: When to Beware

What is often a hand-off? It’s every time a patient transfers from one set of choice to another. Common these include:

nursing where you can hospital (and back again)  hospital to rehabilitation facility  hospital to hospice care

Thousands upon a huge number of patient transfers occur daily. Articles inside the Wall Street Journal yesterday quoted the President from the organization that accredits hospitals and other health care facilities (The Joint Commission) as stating:

There are 4,000 hand-offs a day in the typical teaching hospital. If 90% go flawlessly, that’s still 400 failures each day.

The Joint Commission collaborated with 10 hospitals and systems that volunteered to participate in inside a project led with the Commission and located that transfers were defective 37% of the time. So if I do the math here, a teaching hospital which has 4,000 hand-offs a DAY could be from the average to have 1480 flawed communications PER DAY when transferring care into, or away from, a medical facility setting. Houston, we have a problem! Within the Journal article is often a link to the chart from the Commissions’ Report that documents the validated root causes for hand-off communication failures. There are 4 causes (from 20) that were identified that jumped out at me. Three in the 4 were reported by 7 of the 10 participating hospitals:

Culture will not promote successful hand-off, e.g. lack of teamwork and respect  Expectations between sender and receiver differ, Sender, who may have little expertise in a patient, is handing off the patient to receiver

The 4th one was validated at everyone with the 10 hospitals. These are not small, the community includes Johns Hopkins, Mayo Clinic, NY Presbyterian, and Massachusetts General. The most common source of hand-off failure was:

The sender provides inaccurate or incomplete information, e.g. medication list, DNR [Do Not Resuscitate], concerns/issues, contact information.

I cannot say this often enough. Patients must have a trusted family member or friend creating a file with the patient’s care history and reviewing that care history with every new facility or physician who cares for the patient. The good news is organizations like The Joint Commission now get sucked in and recognize the dire requirement for quality controls. The bad news is change takes time and while the incidence of medical errors will (hopefully) ultimately decrease significantly, danger won’t be eliminated.

Reference: Joint Commission-Hospital Collaboration Targets Hand-Offs