Patient Medical Information Lost During Shift Changes
You are in the hospital and your doctor has left for the day. Does the next doctor have all your important patient medical information, or has some or most of it been lost during the hand off? Unfortunately, a new study shows that most important patient information is not completely or effectively transferred to the incoming physician more than half of the time.
Effective communication skills are important in most occupations, and especially in those that deal with life-and-death situations. Doctors and other medical professionals who handle important information about patients are expected to accurately and responsibly convey that information to ensure there is no breakdown or errors in patient care.
In their study of pediatric interns, University of Chicago Medical Center investigators observed the transfer of information between the first-year residents at Comer Children’s Hospital, who typically spent 10 to 15 minutes providing information about patients to the residents who were relieving them. This hand-off of information was conducted in a designated hand-off room.
The investigators discovered that the information that the outgoing intern believed was the most critical information was not communicated successfully to the incoming intern 60 percent of the time. Residents coming onto the new shift sometimes had no understanding of why patients were taking specific medications or the rationale for other important medical decisions in most cases.
Despite this apparent failure to effectively communicate important patient information, the residents in the study believed they had done so.
The implications of these study results are worrisome in terms of patient care and the possibility of medical errors. The study also emphasizes the need to help doctors learn effective communication skills and it highlights the risks associated with increasing the number of opportunities for such miscommunication to occur.
This is a concern expressed by Vineet Arora, MD, assistant professor of medicine at the University of Chicago Medical Center, who commented on the limitations placed on resident work hours. “When resident hours are shortened,” Arora said, “you have more hand-offs.” Clinicians are then faced with two options: physicians who are tired but who know their patients or rested doctors who may not know the patients as well.
Another disturbing thought that these results bring to the fore is that the communication transfer was done in ideal conditions, in a special hand-off room, yet many hospitals have less formalized hand-off procedures or none at all. So is even more patient information being miscommunicated in other hospitals?
The authors of this study are already working on ways to improve how doctors hand-off patient information at shift changes. A simulation exercise designed to train medical students on how to communicate effectively during hand-offs is under development. This study’s findings can also serve as a wake-up call for hospitalized patients and their families to be vigilant and to ask questions of healthcare professionals when they or loved ones are in the hospital.
University of Chicago Medical Center news release Mar. 11, 2010