News & Commentary

Patient Handoffs Hit Communication Snag


Transferring patients efficiently and safely from the emergency department to other parts of the hospital takes good communication, but too often clinical data wind up missing in action.

Surveys of the emergency medicine department and five medical admitting services at a 627-bed tertiary care academic medical center found that ineffective communication hobbles handoffs and endangers patients.

Researchers at the University of Nebraska Medical Center College of Medicine noted that most research into handoffs has focused on the process within units so their research into handoffs among units explores some less charted territory.

Their study, published in the July issue of the Journal of Hospital Medicine, identified tension between emergency medicine physicians and those on the admitting units.

Ninety-four percent of emergency physicians felt defensive at least sometimes—and perhaps with good reason.

“EM physicians frequently felt that admitting physicians did not trust their clinical decisions, a perception supported by the fact that over 25% of admitting respondents’ usually disagreed with decisions in the ED,” the study states.

One of the problems is a fundamental lack of trust. Another is that physicians often don’t know the experience level of the doctors that they are handing off to. The study states that “less experienced clinicians may require explicit information that a more experienced provider may infer.”

The number of handoffs in American hospitals has increased partly because of rules limiting the number of hours that residents can work. But computer-based tools that standardize patient information and handoffs have been found to reduce medical errors and preventable adverse events.

The Nebraska researchers say that they want to work out a better handoff system and are “pilot testing a standardized approach for ED-to-hospital handoffs….”