Communication breakdown in hospital hand-offs

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Transferring the care of a patient from one physician to another is a standard—and necessary—part of hospital care. Yet, among trainee doctors, important information often gets overlooked during these hand-offs, according to a new study published in the March issue of the journal Pediatrics. Researchers at the University of Chicago studied hand-off communication among first-year medical residents (also known as interns) at Comer Children’s Hospital at the University of Chicago. At the end of overnight shifts, the outgoing doctor would sit down with the incoming one for 10 to 15 minutes to discuss the patients’ whose care was being transferred. After this exchange, both doctors were asked independently to explain the most important information conveyed about each patient. Despite confidence on both sides about the effective exchange, in 60% of cases, the two doctors crossed signals about what information was most important.

In particular, the most frequent information break-down had to do with the oncoming physician’s understanding of why a patient was taking a particular prescription medication, or, if there was a recommendation to contact the primary care doctor, what this contact was supposed to be about. The study authors say that the high rate of miscommunication is particularly alarming considering that doctors at Comer Children’s Hospital do hand-offs under conditions—in a separate room designated for hand-offs, and under the supervision of more tenured doctors.

The study highlights the need for improving verbal communication skills for these critical hand-offs to ensure that young doctors are equipped with the information that they need to make decisions in patients’ best interest, the authors conclude.

This study adds to an ongoing debate about the best way to optimize doctor training programs, an issue currently being scrutinized by the Accreditation Council for General Medical Education, the body that accredits medical residency programs in the U.S. In working to improve patient care, considering the impact of physicians’ exhaustion, hand-off communication and shift-length are all critical components.