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Making Patient Hand-offs In The Hospital Safer

July 30, 2008

One consequence of restricting resident physician work hours is an increased frequency of patient hand-offs between doctors.  An excellent article appearing in Slate today details the problem.  One solution offered is to have standardized electronic hand-off systems:

The best way to [provide physicians with all relevant information] is for teaching hospitals to have standardized, electronic handoff systems. In medicine, as in aviation, most errors occur at transitions: by pilots, during takeoff and landing, and by doctors, after handoffs. Because of work limits, an intern today might be involved in more than 300 handoffs during an average monthlong rotation. Too many hospitals continue to rely on one intern signing out verbally to another, an invitation for error. Less than 5 percent of hospitals have electronic handoff systems in place.

Such a system could and should be an integral part of a hospital’s electronic medical record system.  The record system could automatically generate a “hand-off page” that would pull all of the most important information (current diagnosis, current medication, medication allergies, relevant history, etc.) to be conveyed to the incoming physician.  The physician handing the patient off could also go through the medical record and highlight any particularly relevant information so that it is displayed on the “hand-off page” as well.  When it is time for the actual hand-off to occur, both physicians (the outgoing and incoming) could electronically sign the bottom of the “hand-off page”, indicating they discussed the patient and what steps should be taken during the patient’s care under the new physician.

Not only does this efficiently convey the most important information, it also provides an opportunity to critique a patient’s care should a medical error occur.  If a patient was given inappropriate care during the overnight float, physicians could go back to the “hand-off page” and see what information was conveyed and if the error was a result of something omitted during the transition.

Having automatically generated “hand-off pages” is just one more addition to the long list of what electronic medical records may be able to do.  It is important to develop these ancillary benefits while continuing to work towards greater integration of health informatics into the everyday practice of medicine.

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