Malpractice Dangers in the Patient Handoff

Mark Crane, BA

Disclosures

May 17, 2017

In This Article

How Culture Can Sabotage the Handoff

The culture of a hospital or medical community can have a big impact on whether a handoff is more likely to succeed or fail.

"There's been a growing attention to how the organizational culture affect the risk at the handoff," said Rick Boothman, JD, chief risk officer at the University of Michigan Health System and a malpractice defense attorney. "Hierarchical cultures are likely to have greater problems because staff are afraid to ask questions. Residents may be afraid to appear uninformed or even stupid if they raise issues."

"Let's say I'm an operating room nurse," says CRICO's Dana Siegel. "I know the patient has a latex allergy. The surgeon puts on his latex gloves, but no one speaks up because he has a fierce temper. People are afraid to speak up. They fear being yelled at or that they might be wrong.

"Nurses may notice patients in the recovery room developing infections, or bleeding. But there's often a fear of calling the attending doctor or letting anyone else know," she said. "The culture is often, 'I'm supposed to learn how to do this on my own. If I call, it's seen as weakness.'"

That's why many institutions formalized protocols so that nurses know when to call, and encourage attendings or supervisors to welcome that call. "They have trigger cards with the scenarios laid out," said Siegel.

Darrell Ranum of The Doctors Company agrees. "Some failures are directly related to the culture within an organization. If nurses are encouraged to speak openly with physicians, they can often provide information and insights learned from working closely with patients. If they hesitate to speak up, valuable information may be stifled.

"The same is true in communications among physicians," Ranum said. "If a specialist expresses anger at being called at night, hospitalists and nurses may hesitate to contact them when their patient's condition deteriorates, delaying the needed response."

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