Effective hospital patient 'handoffs' require better training for physicians

A study in the December issue of Academic Medicine asks: what happens when a hospital patient's physician goes off duty and another physician assumes responsibility for the patient?

The answer: An efficient and safe patient handoff often does not occur, probably because physicians, unlike air traffic controllers and others who perform vital handoffs, do not receive adequate training in how to communicate during these transfers of responsibility and across different information systems.

The solution: Teach physicians the handoff process using a model based on principles of adult learning, effective feedback and clinical experience.

Poor communication in medical practice is one of the most common causes of medical errors, according to the study's senior author, Richard M. Frankel, Ph.D., professor of medicine at the Indiana University School of Medicine, and a research scientist at the Health Services Research and Development Center on Implementing Evidence-Based Practice, Richard L. Roudebush Veterans Affairs Medical Center and the Regenstrief Institute, Inc.

"Our study poses two very basic questions. First we asked: 'Can we afford to spend the time, effort, and dollars involved in additional training of physicians? And then we asked: Can we afford not to?'" said Dr. Frankel.

A precise patient handoff from one physician to the next is critical to patient safety and care, said Dr. Frankel, a medical sociologist who studies physician communication.

"The safest method of transferring responsibility for a patient is a face-to-face handoff in which the physician going off duty talks directly with the physician coming on duty," Dr. Frankel said.

"Computerized medical records can facilitate face-to-face handoffs. Body language and other crucial factors are lost when the handoff is done over the phone and a written handoff may be difficult to read -- doctors have notoriously poor penmanship -- errors especially in numbers or decimal places are easy to make, and written notes are open to misinterpretation or misplacement."

Co-authors of Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs are Darrell J. Solet, M.D., J. Michael Norvell, M.D., and Gale H. Rutan, M.D., M.P.H.. The study was funded in part by the Health Services Research and Development Center on Implementing Evidence-Based Practice, Richard L. Roudebush Veterans Affairs Medical Center.

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