An intervention to improve communication and provide more structure to patient "handoffs" among residents dramatically reduced medical errors and preventable adverse events in hospitalized children, according to a report published online Dec. 3 in JAMA.
In a single-center study comparing patient handoffs during the 3-month period before the intervention was implemented against the 3-month period afterward, the rate of medical errors dropped by 46%, from 33.8/100 admissions to 18.3/100. Preventable adverse events similarly decreased, from 3.3/100 admissions to 1.5/100, said Dr. Amy J. Starmer of Boston Children’s Hospital and Harvard Medical School, Boston, and her associates.
"Given the increasing frequency of handoffs in hospitals following resident work-hour reductions and the high frequency with which miscommunications lead to serious medical errors," widespread use of such handoff interventions could have a substantial impact on patient health, they noted.
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Handoff interventions and improving doctor-to-doctor communications could have a substantial impact on patient health, experts say.
The investigators performed the before-and-after comparison on two inpatient pediatric units within the same hospital, which included 1,255 children requiring general, subspecialty, and complex-care services during the study period. A total of 42 first-year and third-year residents cared for these patients and participated in the intervention.
Before the intervention, patient handoffs had no standardized structure and involved the use of a printed document that included basic patient information but was not integrated into the electronic health record system.
For the intervention, the residents attended a 2-hour training session in which they discussed best practices for verbal and written handoffs. Handoff procedures were structured to occur on a team basis rather than individually, in a dedicated physical space that was private and quiet, and which were periodically overseen by a chief resident or attending physician.
One of the pediatric units also began using a computerized rather than printed handoff document that was integrated into the electronic health record system and included much more detailed, and regularly updated, patient information.
Overall, 350 medical errors and adverse events were tabulated during the study period, including 77% related to medications, 8.3% related to medical procedures, 4.3% related to diagnostic tests, 3.4% related to other therapies, and 3.7% related to falls.
In particular, the rate of errors that could have had important clinical consequences dropped from 7.3/100 to 3.3/100 admissions, and the rate of errors that could have had such consequences but were prevented decreased from 15/100 to 8.3/100 admissions.
As expected, the rate of nonpreventable errors remained constant (JAMA 2013 Dec. 3 [doi:10.1001/jama.2013.281961]).
Forty of the written handoff documents were reviewed for the presence of 14 important items of patient information. After the intervention, the number of key data omissions was significantly reduced.
"Written handoffs were more comprehensive after the interventions, and verbal handoffs were more likely to occur in a quiet, private location," Dr. Starmer and her associates said.
This study was supported by the Controlled Risk Insurance Company Risk Management Foundation, Boston Children’s Hospital Program for Patient Safety and Quality Research, the Agency for Healthcare Research and Quality, the Child Health Corporation of America, and the National Institutes of Health. No financial conflicts of interest were reported.