For residents, knowing how to communicate crucial handoff details is a skill learned on the job. Those details boil down to two questions: 1) What is the bottom line for each patient? and 2) What are the potential interventions if a patient deviates from what is expected? With more groups of people overseeing patients in an era of restricted medical resident work hours, the potential for missed details has increased.
How should handoffs work? “There is a basic expectation that physicians transfer relevant information to colleagues in instances in which they are not available to their patients 24/7,” said Ingrid Philibert, PhD, MBA, ACGME’s senior vice president of the department of field activities. “This predated the duty hour limits, but the limits increased the frequency of handoffs and made the consequences of no, or suboptimal, handoffs much more prominent.” With additional people taking over responsibility for patients over any given day or week, there are “more opportunities for missed, erroneous or distorted information being transferred during these handoffs,” she added.
In a surgical specialty such as otolaryngology, things “operate in a culture in which the physician has traditionally been available to his or her patients 24/7,” Dr. Philibert said. “There are patient safety and learning benefits in peri-operative continuity that are not fully compensated by good handoffs—particularly if there are post-operative complications where the surgeons who performed the operation are in a better position to provide treatment than another physician, even when armed with complete and accurate handoff information.”