Laird Harrison

October 28, 2014

SAN FRANCISCO — A checklist can improve communication and reduce errors when one doctor hands a patient off to another, a new study shows.

"This is something that can be used broadly to improve communication," said Nicole Tapia, MD, a fourth-year resident at Baylor College of Medicine in Houston.

She presented the findings here at the American College of Surgeons 2014 Clinical Congress.

Baylor has implemented a protocol for the shift change called PACT — priority, admissions, changes, task review. Physicians are encouraged to discuss the sickest patients first, followed by new admissions, changes to current patients, and then to review tasks.

In a previous study, Dr Tapia and her colleagues found that after the implementation of PACT, residents completed more tasks and knew more about patients on morning rounds (J Surg Res. 2013;184:71-77). In addition, the discrepancy between junior and senior handoffs diminished, and senior residents had more confidence in the ability of junior residents to handle emergencies.

To further improve communication, the researchers used a focus group to design a 4-item checklist that calls on physicians to designate a leader, premark their handoff list, move to a quiet place, and set communication devices to vibrate.

The researchers then compared 146 handoffs — 71 using PACT with the checklist and 75 using PACT alone.

The handoffs using the checklist went faster and had fewer errors.

Table. Comparison of Handoffs

Parameter PACT With Checklist PACT Alone P Value
Census of patients (n) 33 34 .34
Handoff time (minutes) 15 22 .001
Interruptions (n) 2 4 .003
Average errors per shift (n) 0 .03 .003
Incomplete tasks per shift (%) 28 27 .93
Unknown patient information (n) 32 30 .79

 

Despite these improvements, the checklist did not appear to improve the confidence of junior staff to communicate during handoff. On average, those using the checklist did not report a significantly better ability to answer nurses or senior staff than those not using the checklist, a better knowledge of patients, or a better ability to handle emergencies.

Senior staff did not report changes in most of these parameters either, except they did think the interns using the checklist had a better ability to answer their questions about patients.

Also, although the checklist resulted in high-priority patients being discussed more often, residents indicated that they preferred discussing patients in order of location in the hospital.

Cultural factors, as well as structural ones, are important in bringing about change, said Lillian Kao, MD, associate professor of surgery and critical care at the University of Texas Medical School at Houston, who was not involved in the study.

Addressing attitudes in the institution might help put more focus on the most acutely ill patients, she said. "Today, communication seems to be a major theme."

Dr Tapia and Dr Kao have disclosed no relevant financial relationships.

American College of Surgeons (ACS) 2014 Clinical Congress. Presented October 27, 2014.

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