In 2006, the Joint Commission Sentinel Event report indicated that an “evaluation of more than 3,000 root cause analyses done from 1995 to 2004 found that more than 65% of sentinel events in accredited health care organizations were caused by communication problems; in 2005, that percentage was nearly 70%.”
Experts agree that breakdowns in hand-offs are a leading cause of malpractice or lawsuits, and the Princeton Insurance claims database indicates that communication issues represent one of the most common risk management issues.
In healthcare, the transfer of information between providers and patients and among providers themselves is a process that is at the crux of, and can either define or hinder, optimum care. It is for this reason that the Joint Commission has included the improvement of communication among providers and the standardization of hand-off communication as a National Patient Safety Goal.
Dr. Christopher Landrigan, director of the Patient Safety Program at Brigham and Women’s Hospital in Boston, defines “handoff” as the transfer of patient information and responsibility between healthcare providers. He calls this a critical point of vulnerability for communication errors.
Oftentimes, the interaction between staff in the hospital is harried and involves various styles of communication. Recognizing this problem-prone and high-risk period, patient safety advocates recommend standardizing the approach to handoffs in order to improve the effectiveness of communication. The goal of standardizing handoffs is to bridge the gap between the narrative methods used by the sender in explaining a situation and the receiver’s desire to hear only the “headlines” of a situation.
Ideally, an effective handoff should be uninterrupted and allow for an interactive exchange of relevant patient information. This gives the incoming caregiver an opportunity to clarify any uncertainties and review relevant patient history or information. It should also require the use of a repeat-back process for the verification of the received information.
Current review of literature on the implementation of standardized methods of handling patient handoffs indicates that different institutions are at different stages of development; however, it also demonstrates ongoing activity in improving the process.
One of the most common techniques extensively used is the SBAR method and was recently reformulated to include another R (+R). The acronym stands for:
S – Situation: What is happening at the present time?
B - Background: What are the circumstances leading up to this situation?
A – Assessment: What do I think the problem is?
R – Recommendation: What should we do to correct the problem?
R – Repeat Back: Review - What did we decide to do? The process continues until a “shared” understanding is verified.
SBAR + R can be used in nearly any communication medium, in both urgent and critical situations. It helps a person organize his or her communication in a way that ensures common understanding and avoid confusion and potential gaps in the transfer of information.
Some organizations have developed modified versions of SBAR+R.