Inadequate Transfer of Patient Care in Hospitals Unnecessarily Endangers Patients November 8, 2013.
Hospitals like to project an image as high-tech, well-oiled machines that provide efficient care to every patient, every time. As patients, or potential patients, we want to believe this impression, but a look behind glossy hospital advertisements reveals some disturbing problems with how hospitals provide basic medical care.
Take, for instance, a patient hand-off, also known as a sign out. This is the process by which an outgoing shift of doctors transfers the care of hospitalized patients to the incoming shift of doctors. Most often, these doctors are medical residents, physicians-in-training who have completed medical school and work long hours in hospitals caring for patients.
Surprisingly, the sign-out process is not discussed much in medical school or residency. "Patient handoffs are a non-standardized process and a skill that’s not even taught," pediatrician Ted Sectish told the New York Times in a recent article on the subject.
Indeed, a 2006 study from the Archives of Internal Medicine found that 60 percent of medical residency programs did not provide any lectures or workshops on sign-out skills. Worse yet, the study found that 55 percent of programs did not consistently require both a written and an oral sign-out at transfers of care, 34 percent left sign-outs to residents alone, without the participation of the supervising doctor, and 59 percent of programs had no means of informing nurses that a transfer had taken place.
What does this mean for patient safety? A lot. If the doctor ending his shift does not accurately and thoroughly convey a patient’s condition to the doctor beginning his shift, the patient’s safety and well-being is unnecessarily put at risk. Even something as simple as a test or X-ray result can be lost in the transition, leading to catastrophic consequences for the patient.
"Residency programs need to recognize the problem and address it in some way," Dr. Leora Horwitz told medical journal The Hospitalist.
Medical schools and residency programs need to teach best practices for transferring patient care between shifts at a hospital. The process needs to be standardized both throughout a hospital and throughout the country. Also, supervising staff physicians need to provide better hands-on training and model good patient hand-off practices.
Studies have proven that hospitals can keep patients safer, reduce medical errors, and improve patient care when they take steps to assure a smooth and thorough patient hand-off. One study, published in the journal Teaching and Learning in Medicine, found the use of standardized written sign-out sheets significantly improved the completeness and effectiveness of hand-offs between night and day medical residents.