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







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




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




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





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