Increasingly, as healthcare organizations try to create a culture of safety and reduce risk, one of the essential elements they focus on is communication.
“Effective communication supports and enhances patient safety and quality of care throughout an organization. Good communication promotes effective teamwork, weaves threads of continuity and clarity throughout an org, and ensures that important pieces of information are shared with all individuals involved a patient’s care. …Conversely, breakdowns in communication can cause a wide range of medical errors, including incorrect treatment, delays in treatment or missed treatment. Critical information can get overlooked, not conveyed, forgotten or misdirected. …The consequence of these lapses in communication can range from mild patient frustration to serious harm and possible death.”
“Leaders set the tone for effective communication by creating a culture that emphasizes cooperation, team work, open and honest communication, collaboration and respect.” Creating a culture of communication is an ongoing process.
Communication at the Patient “Hand-off”
It is not unusual for a patient in an acute care hospital setting to be cared for by 4 or more different units during a single stay. The following are typical examples:
- Operating room (“OR”)
- Post anesthesia care unit
- Critical care unit
- Step-down unit
- Medical/surgical unit
The term “hand-off” refers to the transfer of responsibility for a patient’s care when a patient is moved to another unit or turned over to a new nurse or doctor. The information exchanged during a hand-off should be accurate to ensure the patient’s safety. Common hand-off scenarios include:
- Nursing shift changes
- Temporary relief when staff leave a unit for a short time
- Nursing and physician hand-offs from emergency department to in-patient unit
- Patient is moved from one in-patient setting to another (e.g.: OR to ICU, etc.)
- Patient transfers out of one hospital to another hospital, nursing home or home care
Dangerous errors and omissions in communication among responsible caregivers and between caregivers and the patient can, and often do, occur during the patient hand-off. Thus, to help ensure that hand-off information is accurate, the JCAHO has recommended that organizations establish standardized procedures for hand-off communication. The JCAHO has published the following strategies to help reduce errors and improve hand-off communication:
- Use clear language (define terms, no abbreviations or jargon that could be misinterpreted)
- Incorporate effective communication techniques.
- Standardize shift-to-shift and unit-to–unit reporting. Organizations may want to consider using the Situation-Background-Assessment-Recommendation (SBAR) techniques to standardize communications. (Further discussion of this subject is beyond the scope of this article.)
- Smooth hand-offs between setting
- Use technology to your advantage (e.g. electronic medical records)
Another organization, The Institute of Medicine, warned in its now famous report, Crossing the Quality Chasm, that patient hand-offs provide opportunity for error. The report emphasized that “in a safe system, information is not lost, inaccessible, or forgotten in transitions.”
Joint Commission Perspectives on Patient Safety, July 2005, Volume 5, Issue 7 (p. 11)