What’s New in the Patient Safety World
March 2017
Adding Structure to Multidisciplinary Rounds
We’ve done many columns on handoffs/handovers and are advocates of using structured tools to facilitate such. There is certainly no shortage of structured tools and formats for handoffs (see our February 14, 2012 Patient Safety Tip of the Week “Handoffs – More Than Battle of the Mnemonics” and the many columns listed below).
One problem we’ve always encountered is that some patients may get “shortchanged” in such handoffs depending upon time limitations and the order of prioritization, i.e. patients discussed earlier in the handoff tend to be discussed in more detail. In our January 29, 2013 Patient Safety Tip of the Week “A Flurry of Activity on Handoffs” we noted a handoff study (Cohen 2012) which showed that in intensive care unit attending-to-attending handoffs at the end of the week, patients discussed earlier had a disproportionate amount of time allocated. This finding was irrespective of the severity or complexity of the patient’s case. Cases earliest in the handoff sessions had about 50% more time in discussion that those discussed toward the end of the handoff.
Now a new study has looked at the impact of two structured handoff tools on multidisciplinary rounds (Abraham 2016). The researchers compared multidisciplinary rounds (MDR’s) in two comparable MICU’s in an academic medical center. One group used a traditional SOAP format (like we’ve used in progress notes for many years). The other used HAND-IT (Abraham 2012), a tool organized by body systems. They then recorded MDR’s and analyzed them for total duration, duration for individual patients, and interruptions/distractions unrelated to the patient being discussed. They did not find that the order of patient presentation impacted time spent on the patient or communication breakdowns. However, for the problem-based (SOAP) tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns. This effect was much less when using the HAND-IT tool. They note that the HAND-IT tool “required more effort and time to gather and document information, but it reduced the time spent and additional effort during rounds to address the information gaps.”
So add one more tool and mnemonic to your handoff toolkit!
Read about many other handoff issues (in both healthcare and other industries) in some of our previous columns:
May 15, 2007 “Communication, Hearback and Other Lessons from Aviation”
May 22, 2007 “More on TeamSTEPPS™”
August 28, 2007 “Lessons
Learned from Transportation Accidents”
December 11, 2007 “Communication…Communication…Communication”
February 26, 2008 “Nightmares….The Hospital at Night”
September 30, 2008 “Hot Topic: Handoffs”
November 18, 2008 “Ticket to Ride: Checklist, Form, or Decision Scorecard?”
December 2008 “Another Good Paper on Handoffs”.
June 30, 2009 “iSoBAR: Australian Clinical Handoffs/Handovers”
April 25, 2009 “Interruptions, Distractions, Inattention…Oops!”
April 13, 2010 “Update
on Handoffs”
July 12, 2011 “Psst!
Pass it on…How a kid’s game can mold good handoffs”
July 19, 2011 “Communication
Across Professions”
November 2011 “Restricted
Housestaff Work Hours and Patient Handoffs”
December 2011 “AORN
Perioperative Handoff Toolkit”
February 14, 2012 “Handoffs – More Than Battle of the Mnemonics”
March 2012 “More
on Perioperative Handoffs”
June 2012 “I-PASS
Results and Resources Now Available”
August 2012 “New
Joint Commission Tools for Improving Handoffs”
August 2012 “Review
of Postoperative Handoffs”
January 29, 2013 “A
Flurry of Activity on Handoffs”
December 10, 2013 “Better
Handoffs, Better Results”
February 11, 2014 “Another
Perioperative Handoff Tool: SWITCH”
March 2014 “The
“Reverse” Perioperative Handoff: ICU to OR”
September 9, 2014 “The
Handback”
December 2014 “I-PASS
Passes the Test”
January 6, 2015 “Yet
Another Handoff: The Intraoperative Handoff”
References:
Cohen MD, Ilan R, Garrett L, et al. The Earlier the Longer: Disproportionate Time Allocated to Patients Discussed Early in Attending Physician Handoff Sessions. Arch Intern Med 2012; 172(22): 1762-1764
http://archinte.jamanetwork.com/article.aspx?articleid=1391009#qundefined
Abraham J, Kannampallil TG, Patel VL, et al. Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study. JMIR Hum Factors 2016; 3(2): e29
https://humanfactors.jmir.org/2016/2/e29/
Abraham J, Kannampallil T, Patel B, et al. Ensuring Patient Safety in Care Transitions: An Empirical Evaluation of a Handoff Intervention Tool. AMIA Annu Symp Proc 2012; 2012: 17-26
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540511/
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