Patient handoffs?

[TNP Editor]

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Hi all, it's Martha, editor of The New Physician magazine.

I am working on a piece about patient handoffs and communications issues that ensue. A new study shows that students and residents are not being trained sufficiently to manage handoffs of patients at shift changes, etc., putting patients at risk of medical errors.

I am interested in learning how students on clinical rotations are being trained to hand off effectively. Is the topic even covered? How?

Do you feel confident that you can do this effectively? How did you learn the best ways of doing this?

Do you have any comments on how this issue can be better addressed? Complaints?

I appreciate any and all comments anyone has on this. I will not quote you without permission. Post your answer here or to [email protected].

I look forward to your responses, soon I hope--deadline looms!

Martha Frase-Blunt
Editor
The New Physician

 

[TNP Editor]

*bump*

 

[Gimlet]

You might have more luck with this question over on the "Clinical Rotations" forum...see if you can get a mod to move it!

 

[robotsonic]

The issue of handing off patients isn't even treated as an issue at my hospital. This is the first time I've ever heard someone talk about the "training" for this. It was never covered formally. Often the intern will give a 2-second explanation of handing off, usually as follows, "Just print out your patient list and write down anything that needs to be done at a certain time. Don't hand off work that you could do before you leave. Only write down the essential information, and let them know if someone is at risk of crashing."

I'm an MS4.

 

[EvoDevo]

I'll move it over to the clinical rotation forum. Good

 

[Hurricane]

I'm an MS4 and at our school on the medicine service we have "check out cards" to give to the night float or cross covering resident, which are 3x5 index cards with a summary of the patient's HPI, PMH, meds, allergies, DNR status, IV status, etc. Then there is a to do list and a warnings list. (labs to check, warnings about pain med seeking, etc)

The quality of these cards is highly variable. When I was taught to do them, my resident said to use the "golden rule" - i.e. make the kind of card I would like to get if I were cross covering. Basically, we try to make the cards idiot proof and very specific. So instead of writing something vague like "check renal" we put more specifc instructions about the thing we are looking for, like "check 6pm renal, if Mg < 1.2 then give 2 g Mg sulfate IV x1"

Many crosscover headaches are due at least in part to vague, minimal crosscover cards. Other times it's because of residents who put a lot of scut on the to do list, which IMO is a breach of etiquette. And don't get me started on the people who are too lazy to write out the med doses on the cards. So when the nurse calls wanting to know if they can give another dose of whatever, you don't know how much they're on to begin with. And people who don't write the IVFs on the med list - another pet peeve of mine. Call me anal, but I don't think you can be too anal with making check out cards.

Another issue I've seen... at our school the paging system automatically forwards pages to the night float after 10pm. And I've seen the night float hopping mad because an intern was still working up a patient and hadn't made and handed off a card, and the patient was unstable, so the night float was getting constant pages about a patient he knew nothing about.

Anyway, rereading what I just wrote, it makes our hospital sound pretty awful. But most of the time handoffs go quite smoothly and there are no issues. But when these issues do come up, I have found myself thinking that if I were a patient, I might not want to know how the cross cover system works. Like laws and sausages, y'know...

 

[cheech10]

We have patient lists that include bulleted lists of: ID, relevant PMH, very brief presenting complaint/HPI, and ongoing issues and plans. Also have specific instructions for the covering intern. It's a text file stored on the ward computers, and updated before sign-out every night. Works well, except for needing to add all the new admissions post-call which can take about an hour.