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Improving patient safety

Hospital residents report patient-handoff problems common, can lead to patient harm

A significant percentage of resident physicians report that patient handoffs - transfer of responsibility for a hospitalised patient from one resident to another - contributed to incidents in which harm was done to patients.

The study, published in the October 2008 Joint Commission Journal on Quality and Patient Safety, identifies situations in which problematic handoffs are more likely to occur and factors that may interfere with the smooth transfer of crucial information.

"Our findings suggest that patient harm from problematic handoffs is common," says Dr Barry Kitch, of the Massachusetts General Hosptal (MGH) Institute for Health Policy and Harvard Medical School (HMS), lead author of the study. "In fact, problematic handoffs may be as significant a source of serious patient harm as are medication-related events."

Several previous studies have shown that handoffs can contribute to adverse events - preventable injuries that do not result from patients' underlying medical condition - and concerns about potential handoff-related hazards have increased since restrictions on the hours that residents can work require even more frequent handoffs.

The current study, conducted late in 2006, was designed to analyse residents' experience with handoffs and their perception of how often handoffs were a factor in adverse events.

Surveys were distributed to 238 MGH medical or surgical residents, asking about their experiences with handoffs during their most recent inpatient rotations. Questions included how much time they spent preparing for and taking part in handoffs; the types of information involved in handoffs; how often important information was missing, complete or inaccurate; factors associated with problematic handoffs; and how many patients experienced harm attributed to such handoffs.

Completed surveys were returned by 161 residents, a response rate of almost 68%; and more than half the respondents reported at least one incident of handoff-related patient harm during their month-long inpatient rotations.

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