Issue of Miscommunication in Handoff Procedures

Proposal

Miscommunication during handoff between departments is an interdepartmental issue at Bridgeport Hospital. Miscommunication in reports can cause increased patient falls, incorrect administration of medications, misunderstanding of orders, etc. (Campbell & Dontje, 2019). In a study, reviewing ten hospitals, “37% of interdepartmental handoffs were substandard and did not support high quality patient care” (Wisniowski, 2010). This means that 37% of patients potentially could have had an, otherwise preventable, adverse event in the hospital due to poor communication. One of Bridgeport Hospital's values is to provide "high quality patient care," therefore to uphold this value, it is critical that the current issue of interdepartmental handoff be addressed.

Current

Currently there is a healthcare policy in place at Bridgeport Hospital addressing handoffs between departments, but it is not enforced nor is it easily accessible to employees, making the policy ineffective. The policy does not have a structured standardized format for handoff, as handoff can be "verbal, written, faxed or electronic" (Yale New Haven Health, 2018). The various forms of communication stated can cause inconsistencies with handoff reports and confusion among the receiving department, creating areas for error. At present, in order to find the current policy, one must click on the internet, which brings him/her to the hospital's “intranet” page, find the "policies" link, select the specific hospital, and input keywords to bring up the policy. This multi-step process can deter employees from finding/referencing the interdepartmental handoff policy, resulting in practice behaviors that are not supported by evidence-based research (EBR). In addition, as a result of poor interdepartmental communication, there are patients who “fall through the system”, such as with the transfer from the Emergency Department to General Medicine floor, that are not assigned to either providers because each team assumes the other party is still responsible for the patient’s care (Smith et al., 2018). Not only is this a major concern for patient safety, but in the event that there is a critical change or concern, treatment may be delayed due to difficulties contacting the appropriate provider.

Changes

Implementing a standardized electronic form/template when performing interdepartmental handoff report would be a positive change to the current healthcare initiative in place. In doing so, would decrease ambiguity between reports and create a system of organization. Research supports positive correlations between interdepartmental handoff and standardization tools for communication (Smith et al., 2018).  Even so, there are still many healthcare professionals, who either, do not see the importance of these tools or are not trained to use them during handoff. “In a study of 750 physicians, only one third of medical residents received training and 18% used standardization tools during patient handoff” (Smith et. al., 2018, p.373). In addition, this improvement to the current policy would be easily accessible to health care members, as it would be a part of the electronic health record (EHR), which eliminates a paper trail that can easily be misplaced within transfers. The template would follow the Situation, Background, Assessment, Recommendations (SBAR) format, which is a concise, objective communication tool.  This tool allows the receiving unit to develop a wholistic image of the patient and situation, what has been done, and disposition plan for the future. It also given the receiving unit an opportunity to ask questions for clarification and verify details.

Affect

These changes would affect the current healthcare policy because it requires additional charting, separate from verbal report. The new standardized handoff template would be attached to the EHR, so that during verbal report, the receiver can follow along and verify information, without searching the detailed chart.

Departments 

The implementation of this new policy will affect leaders/managers of the organization, staff members directly involved in patient care and all units that send/receive patients. Any culture change that deviates from the “normal” requires consistent education, teamwork, and reinforcement. In a study by Roberts, Putnam, and Raup (2012), an interdepartmental ticket was designed to improved communication between departments in one hospital. The Chief Nursing Officer made it her goal to support this cultural change by attending regional meetings discussing how this change can increase patient safety; as a result, her actions made the staff feel more empowered and driven to implement the change (Roberts et al., 2012). Staff members involved in direct patient care will be affected by this policy change because in addition to calling verbal report between units, employees are now required to follow/complete an electronic standardized template. Although, this may seem like additional work, evidence has proven that standardized templates can improve patient safety. Lastly, the units that send/receive patient will be affected by this policy because there is an increase accountability for information that is missed, omitted or forgotten. Both parties (sending and receiving departments) are responsible for reporting accurate information, and as a result, medication errors, duplicate treatment, and so on, can be avoided.

References

• Campbell, D., Dontje, K. (2019). Implementing Bedside Handoff in the Emergency Department: A Practice Improvement Project. Journal of Emergency Nursing, 2, https://doi-org.ezproxy.snhu.edu/10.1016/j.jen.2018.09.007
• Roberts, M., Putnam, J., & Raup, G. H. (2012). The Interdepartmental Ticket (IT) Factor: Enhancing Communication to Improve Quality. Journal of Nursing Care Quality, 27(3), 247–252. Retrieved from https://search-ebscohost-com.ezproxy.snhu.edu/login.aspx?direct=true&db=ccm&AN=108125705&site=eds-live&scope=site
• Smith, C. J., Buzalko, R. J., Anderson, N., Michalski, J., Warchol, J., Ducey, S.,  Branecki, C. E. (2018). Evaluation of a Novel Handoff Communication Strategy for Patients Admitted from the Emergency Department, (2). https://doi-org.ezproxy.snhu.edu/10.5811/westjem.2017.9.35121.
• Wisniowski, C. (2010). Hospitals are making patient journey safer through better communication. AHA News. 46(24):6–7.
• Yale New Haven Health. (2018). Handoff Communication and Transfer of Care. Retrieved from https://ynhh.ellucid.com/documents/view/9874