Better Communication Can Reduce Injuries During Patient Hand-Offs

November 6, 2014

Improvements in verbal and written communication between healthcare providers during patient hand-offs can reduce injuries due to medical errors.

Reported in the New England Journal of Medicine, researchers at Walter Reed National Military Medical Center (WRNMMC) and the Uniformed Services University of Health Sciences (USU) recognized this critical safety concern and teamed up with nine civilian hospitals to develop I-PASS, an original system of bundled communication and team-training tools for hand-off of patient care between providers. The study revealed a remarkable 30 percent reduction in injuries due to medical errors after its implementation across all 9 institutions.

According to the Joint Commission, ineffective hand-off communication is recognized as a critical patient safety problem in health care; in fact, an estimated 80 percent of serious medical errors involve miscommunication between caregivers during the transfer of patients. The hand-off process involves “givers,” those caregivers transmitting patient information and transitioning the care of a patient to the next clinician, and “receivers,” those care-givers who accept the patient information and care of that patient. In addition to causing patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital.

As the first military hospital to adopt the I-PASS hand-off bundle, which includes training in team communication skills, a verbal hand-off process organized around the verbal mnemonic “I-PASS” (Illness severity, Patient summary, Action List, Situational awareness and contingency planning, and Synthesis by receiver), a written or computerized hand-off tool that reflects the verbal mnemonic, a faculty development and observation program, and an institutional dissemination campaign, Walter Reed Bethesda has now implemented I-PASS for use across multiple disciplines to create an institutional transition of care policy.

According to one of the lead investigators COL Clifton E. Yu, Chief, Graduate Medical Education at Walter Reed Bethesda, “Not only is Walter Reed National Military Medical Center the only military hospital to be involved in the study, but we are also the only study site that was not a major children’s hospital. Taking advantage of that fact, we decided to work towards adapting the curriculum for dissemination across multiple clinical areas, to include adult medicine, surgery, and nursing environments. As our successful institutional roll out is evolving, we are setting the national standard and precedent for the use of I-PASS in all clinical and nursing domains where transitions of patient care typically occur.”

“We were able to use the expertise of USU’s Val G. Hemming Simulation Center to create roleplays and videos simulating handover scenarios. These simulations helped to teach faculty and residents the best practices in transitions of care between patient teams,” said Joseph Lopreiato, M.D., MPH, professor of Pediatrics and associate dean of Simulation at USU. “Thanks to the support from the USU administration, our Simulation Center was able to contribute to this groundbreaking research that will go a long way toward reducing medical errors in the transitions of patient care.”

“A great medical team is like a great relay team: individual effort matters, but victory comes from smooth hand-offs,” said Arthur Kellermann, MD, dean of USU’s F. Edward Hébert School of Medicine.

Source: Uniformed Services University of the Health Sciences (USU)

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