Ineffective handoffs can lead to inappropriate treatment, delays in diagnosis, and potentially life-threatening adverse events.Ineffective handoffs can lead to inappropriate treatment, delays in diagnosis, and potentially life-threatening adverse events.
All of these elements came into play in "Who's is in Charge?" a lesson by David B. Troxel, MD, medical director of The Doctors Company. Each of the Hospitals in the case study missed opportunities to diagnose the patient’s condition due to communication gaps and inattention to documentation among the members of the health care team:
- Hospitalist B did not review the medical record and did not communicate to hospitalist A that the patient fell.
- Neither hospitalist A nor B examined the patient following the fall, and the fall was not communicated to hospitalist C.
- Hospitalist C did not communicate with either A or B about the patient’s inability to stand.
- Hospitalist D failed to communicate the urgency of the MRI to the on-call neurologist.
In “Who’s in Charge?” there are many examples of communication and handoff breakdowns that led to the patient injury. Because the Hospitalist involved in the case study didn’t use a standard set of critical elements to be communicated with each handoff or interaction, there were delays in diagnostic testing and treatment and failures in recognizing the patient’s neurological deficits, which resulted in the unfortunate outcome.
By understanding the problems that can occur during handoffs and planning effective communications, the Hospitals in this case could have minimized risk and enhanced patient safety.
The Shift Toward Hospitalists
Over the last decade there has been a dramatic shift away from primary care–directed hospital care toward a model in which hospital-based physicians—Hospitalists—provide care to inpatients. In fact, the hospitalist field has now become the fastest-growing specialty in the history of American medicine, skyrocketing from 1,000 physicians nationally in the mid-1990s to more than 28,000 today.
Researchers at the University of Texas Medical Branch (UTMB) at Galveston have produced the first quantitative analysis of the increase in the number of Hospitalists. In a paper appearing in the March 12, 2009, issue of the New England Journal of Medicine, UTMB Associate Professor Yong-Fang Kuo used Medicare data to calculate that the percentage of internal medicine physicians practicing as Hospitalists jumped to 19 percent in 2006.
Hospitalists and Effective Communication
The goal of the hospitalist medicine model is to provide a coordinated approach to the care of inpatients. This requires the hospitalist to be skilled in effective communication between physicians and the rest of the hospital clinical team involved in the care of the patient. The processes and systems within the hospital environment create potential barriers to effective communication, in areas including:
- Key information about the patient is unknown
- Poorly defined roles of hospitalist
- High volume of information from many sources
- Lack of standardization of processes
All of the above concerns can be minimized with effective communication techniques and processes.
Ineffective handoffs can lead to inappropriate treatment, delays in diagnosis, and potentially life-threatening adverse events.Ineffective handoffs can lead to inappropriate treatment, delays in diagnosis, and potentially life-threatening adverse events.
All of these elements came into play in "Who's is in Charge?" a lesson by David B. Troxel, MD, medical director of The Doctors Company. Each of the Hospitals in the case study missed opportunities to diagnose the patient’s condition due to communication gaps and inattention to documentation among the members of the health care team:
- Hospitalist B did not review the medical record and did not communicate to hospitalist A that the patient fell.
- Neither hospitalist A nor B examined the patient following the fall, and the fall was not communicated to hospitalist C.
- Hospitalist C did not communicate with either A or B about the patient’s inability to stand.
- Hospitalist D failed to communicate the urgency of the MRI to the on-call neurologist.
In “Who’s in Charge?” there are many examples of communication and handoff breakdowns that led to the patient injury. Because the Hospitals involved in the case study didn’t use a standard set of critical elements to be communicated with each handoff or interaction, there were delays in diagnostic testing and treatment and failures in recognizing the patient’s neurological deficits, which resulted in the unfortunate outcome.
By understanding the problems that can occur during handoffs and planning effective communications, the Hospitals in this case could have minimized risk and enhanced patient safety.
The Shift Toward Hospitals
Over the last decade there has been a dramatic shift away from primary care–directed hospital care toward a model in which hospital-based physicians—Hospitals—provide care to inpatients. In fact, the hospitalist field has now become the fastest-growing specialty in the history of American medicine, skyrocketing from 1,000 physicians nationally in the mid-1990s to more than 28,000 today.
Researchers at the University of Texas Medical Branch (UTMB) at Galveston have produced the first quantitative analysis of the increase in the number of Hospitals. In a paper appearing in the March 12, 2009, issue of the New England Journal of Medicine, UTMB Associate Professor Yong-Fang Kuo used Medicare data to calculate that the percentage of internal medicine physicians practicing as Hospitals jumped to 19 percent in 2006.
Hospitals and Effective Communication
The goal of the hospitalist medicine model is to provide a coordinated approach to the care of inpatients. This requires the hospitalist to be skilled in effective communication between physicians and the rest of the hospital clinical team involved in the care of the patient. The processes and systems within the hospital environment create potential barriers to effective communication, in areas including:
- Key information about the patient is unknown
- Poorly defined roles of hospitalist
- High volume of information from many sources
- Lack of standardization of processes
All of the above concerns can be minimized with effective communication techniques and processes.
