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Weve done many columns on handoffs in multiple
venues and for various specialties. But weve never
done one about radiologists. We.ve done multiple columns on radiologists and
closing the loop to make sure significant imaging findings to not fall
through the cracks. That process is, of course, a form of handoff. But radiologists
also have several other types of handoffs.
A
recent article by Burns et al. (Burns 2021) discussed those handoffs in both diagnostic
and interventional radiology and offered recommended actions.
One
form of handoff is from clinical staff to diagnostic radiology. This
includes exam requests, special precautions (like allergies, isolation, etc.),
initiation of consults, physical transfers, patient registration and
identification, and technologist notes.
These clinician-to-radiology handoffs are critical, given the
host of medical problems that may arise in the radiology suite. The vast majority of patient safety issues that arise in the
radiology suite have little to do with the radiology procedure itself. Rather,
seriously ill patients with complicated problems are sent to radiology and
multiple problems can arise while the patient is in the radiology suite. See
all our columns on such issues listed below. Intrahospital transport of
patients is also a very vulnerable period, and the majority
of such transports are to and from radiology. Our multiple columns on
the Ticket to Ride checklist/handoff (also listed below) have stressed all
the considerations when transporting such patients to and from radiology.
Another
form of handoff is from radiology to clinical staff. This includes
return on consults (communication of choice of appropriate imaging, protocols,
follow-up recommendations, etc.). Also included would be preliminary and final
reports and communication of significant or unexpected findings (see our
columns on closing the loop listed below). It also includes physical transport
of the patient from radiology back to the clinicians and nursing staff.
They then
discuss adaptation of the Institute for Healthcare Improvements (IHI) reliability
science framework for improving handoffs in radiology. They discuss 3 key
levels of actions to improve handoffs:
Strategies targeted to the individual include
training and reminders, standardization, checklists, mnemonics, and active
listening skills. They caution about unclear handwritten orders and
transcriptional errors and emphasize proofreading reports. Even though
voice dictation software has made great strides, we still get reports with some
outrageous mistakes. The authors note that transcriptional errors occur in as
many as 22% of reports. And, unfortunately, we still occasionally see dictated
reports appear in charts stating signed but not read. A focus on active
listening behaviors is something that should apply to everyone in healthcare,
not just radiologists. We always also stress the importance of read back,
hear back, and repeat back to help ensure that all parties understand
communications.
Checklists are important tools in handoffs. They help remind us to pay attention to details
we might otherwise overlook. One checklist they describe for interventional
radiology is called RADPASS (Koetser 2013). Wed again recommend use of Ticket to Ride style
checklists for intrahospital transports (see columns listed below).
Burns et al. also introduced a new mnemonic, I-SCAN, for
handoffs in radiology that is designed to incorporate important elements of I-PASSฎ with
a tighter focus on radiologic findings. I-SCAN can be used in both diagnostic
and interventional practice. I-SCAN stands for:
I Importance of results and identification of
study, patient, sender, receiver
S Summary of imaging findings or interventional
procedure
C Clinical context; any questions or additional
concerns
A And
N Next steps (further imaging, clinical
workup, other recommendations)
Focus on team behaviors includes designation of time
with minimal noise and interruption during handoffs to ensure that the ideas
expressed are completely and clearly reflected. They suggest this can be
achieved in a manner similar
to the time-outs used in
surgery. They also note that simulation practice is another useful tool.
Strategies targeted toward the organization
include steps to promote a culture of safety and Just Culture. This encourages
error reporting and learning without fear of blame or punishment. Error
reporting should include not only incidents with patient harm but also near
misses. And non-punitive peer learning also includes communication of great
calls and great catches.
We refer you to the Burns article itself for
many details of their strategies. Every radiology department or practice can
learn from their work to improve handoffs and patient safety.
And, since we mentioned IPASSฎ, its worth noting that the IPASSฎ
Patient Safety Institute just celebrated its 5-year anniversary. Of
course, studies on IPASSฎ began over a decade ago and it is probably today the
most widely used handoff format and system.
In a recent commentary on a study from Argentina (Jorro-Bar๓n 2021)
that showed IPASSฎ implementation in pediatric intensive care units showed
significant improvement in handoff compliance but failed to reduced adverse
events, Shahian (Shahian 2021)
eloquently discusses the problem of linking handoffs to outcomes and events. He
describes multiple studies that validate the usefulness of IPASSฎ and makes a
plea for more urgent adoption of its principles to improve handoffs at every
level of healthcare.
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 kids 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
March 2017
Adding Structure to Multidisciplinary Rounds
August 22, 2017 OR to ICU Handoff Success
October 2017 Joint Commission Sentinel Event Alert on
Handoffs
October 30, 2018 Interhospital Transfers
April 9, 2019 Handoffs
for Every Occasion
November 2019 I-PASS
Delivers Again
August
2020 New Twist on Resident Work Hours and Patient
Safety
September
29, 2020 ISHAPED
for Nursing Handoffs
See also our other columns on communicating
significant results:
Some of our prior columns on intrahospital
transports and the Ticket to Ride concept:
Some of our prior columns on patient safety
issues in the radiology suite:
ท
October 2020 New Warnings on Implants and MRI
ท
January 2021 New MRI Risk: Face Masks
References:
Burns
J, Ciccarelli S, Mardakhaev E, et al. Handoffs in
Radiology: Minimizing Communication Errors and Improving Care Transitions. JACR
2021; May 11, 2021
https://www.jacr.org/article/S1546-1440(21)00323-9/fulltext
Koetser IC, de Vries EN, van Delden
OM, et al. A checklist to improve patient safety in interventional
radiology. Cardiovasc Intervent Radiol
2013; 36: 312-319
https://link.springer.com/article/10.1007/s00270-012-0395-z
IPASSฎ
Patient Safety Institute
https://www.ipassinstitute.com/
Jorro-Bar๓n F, Suarez-Anzorena I,
Burgos-Pratx R, et al. Handoff improvement and
adverse event reduction programme implementation in paediatric intensive care units in Argentina: a
stepped-wedge trial. BMJ Quality & Safety 2021; Published Online First: 23
April 2021
https://qualitysafety.bmj.com/content/early/2021/04/22/bmjqs-2020-012370
Shahian D. I-PASS handover system: a decade of evidence
demands action. BMJ Quality & Safety 2021; Published Online First: 23 April
2021
https://qualitysafety.bmj.com/content/early/2021/04/22/bmjqs-2021-013314
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