Stacy L. Donnelly, RN, BSN & Christa A. Bakos, RN, CWCN, DAPWCA
What is Patient Hand-Off?
Patients in healthcare facilities commonly receive care and treatment from a team of medical professionals, rather than an individual. Patient hand-off is the process of transitioning a patient to medical personnel within a facility or to a different facility. This written and verbal communication is imperative to patient safety and creates an ongoing record that alerts relevant staff to a patient’s care, treatments, condition, and any recent or anticipated changes.
How Frequently and Why do Hand-Offs Occur?
The average length of a hospital stay is 4-5 days, stays at short term rehabilitation settings average about 20 days, and the average length of stay in nursing homes prior to death is 14 months. During any prolonged stay, patients will come into contact with various providers and caregivers. Nurses change shifts every 8 or 12 hours, depending on the type of facility, and there are often multiple physicians and members of the interdisciplinary team involved in patient/resident care. If a patient’s condition stabilizes, they may be moved to an acute rehabilitation or long-term care facility for additional care, introducing a new set of providers and caregivers.
How Can Hand-Offs Lead to Negative Outcomes or Adverse Events?
Quality medical care often requires a continuum of services within and between medical facilities. If the hand-off fails to adequately relay accurate, timely, and complete information to the receiving professional, the patient faces an increased risk for inappropriate or incomplete care. Patients with allergies, certain pre-existing conditions, or dire prognoses are potentially more susceptible to harm caused by shortcomings in hand-off communications.
What does Appropriate Hand-off Look Like?
Proper patient hand-off requires a combination of verbal and written communication. Standards require that organizations adopt a process that “provides for the opportunity for discussion between the giver and receiver of patient information.” This discussion may include information regarding a patient’s condition, treatment, care plan, and medications. It also allows for the opportunity to discuss any current or anticipated changes that may occur while caring for the patient.
Care providers also rely on the written clinical record to gather data and communicate a patient’s status within the interdisciplinary care team. It is a means for all personnel, even those not present during a transition, to know exactly what/how and why a medical intervention was or was not provided. This written record may be used before, during, and after the verbal hand-off communication to obtain additional data regarding the patient’s condition, treatments, care plan, and medications. This documentation should provide a concise picture of the patient’s progress, including response to treatment, change in condition, and changes in treatment, thus informing the dynamic development of their care plan.
There are several strategies used across the healthcare industry for effective patient hand-off communications. These are facility dependent and may include, among others:
There is not a single foolproof method, but rather a combination of practices that when performed in consideration of the needs of the facility, will assist in creating a safe and effective patient hand-off process.
Patient Hand-off Incident Investigations
Christa A. Bakos, RN, CWCN, DAPWCA, Nursing, Hospital, Home Health & Wound Care Expert and Stacy L. Donnelly RN, BSN, Nursing and Nursing Home Expert can assess whether the standard of care was met when an adverse or sentinel event occurred in a healthcare setting. These investigations may include, among other things, analysis of the facility’s patient hand-off procedures, and whether a failure to communicate between and among personnel affected the patient’s outcome.
Stacy L. Donnelly, RN, BSN & Christa A. Bakos, RN, CWCN, DAPWCA, Nursing Experts with DJS Associates, Inc., can be reached via email at experts@forensicDJS.com or via phone at 215-659-2010.Uncategorized