Malpractice Dangers in the Patient Handoff

Mark Crane, BA

Disclosures

May 17, 2017

In This Article

Progress in Patient Handoffs: Steady But Slow

Increased focus on handoff problems has led to significant improvements, say patient safety leaders. "We've seen many hospitals set up transitional care management protocols. Medicare and private insurers have codes to pay for it," said Elizabeth Woodcock, MBA, a practice management consultant in Atlanta, Georgia.

"Health systems are paying more attention to follow-up care," she said. "We've gone from the days of telling the patient being discharged, 'Here's a piece of paper. Good luck.' There's a deeper commitment to getting the discharge process right. Historically, compliance was thought to be the patient's responsibility. Now there's been a shift in thinking so the hospital and doctors play a greater role."

Rick Boothman said that opportunities for errors at handoffs may be increasing "as our healthcare staff continues to move at a fast pace and our system seems to be working at near capacity all the time. Still, there has been more attention to the act of handing off a patient. In some settings, we've used checklists and hard stops. When anesthesiology brings a pediatric patient up to the intensive care unit after surgery, they cannot leave without a pretty formalized exchange."

"The presence on the floor of a hospitalist who assumes control over the patients on that shift offers a continuity of care that seems to have diminished the sheer number of handoffs and improve the chances that the quality of communication is higher, in part because of the hospitalist's personal proximity to the patient and the care team," he said.

Darrell Ranum of The Doctors Company also sees significant progress. "Coordination of care can be a challenge. As hospitalists and other specialists work together and develop internal policies and procedures, there are fewer instances of confusion where patient care is delayed," he said. "Our study found that when hospitalists and primary doctors follow up early and make adjustments to lessen risks, patients' chances of recovery are improved and hospital readmissions are reduced."

"Some hospitalist groups are sending discharge summaries to primary doctors and making themselves available for a conversation. The groups are also conducting follow-up calls to patients after discharge to make sure that patients understand instructions, to answer questions about treatments or medications, and to inquire about their recovery," Ranum said.

Alan Lembitz of COPIC notes that because hospitals may not get paid if a patient is readmitted within 30 days of discharge, they have stronger incentives to come up with appropriate discharge instructions.

"Things have definitely improved, but the progress has been too slow," said Lembitz. "In my world as a malpractice insurer, people don't call us when things go right. Patients are still being harmed by preventable mistakes."

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