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MIAMI BEACH — Most critical care patients experience at least 20 “handoffs” during their average 4-day hospital stay—handoffs that are “major opportunities for miscommunication” that can lead to errors, Dr. Andrew Shorr said.
“These handoffs happen routinely, and we have little published evidence about them…. If this were going to be an evidence-based talk, I could sit down right now,” he said at the annual congress of the Society of Critical Care Medicine.
He calculated the scope of the ICU problem as follows: two physician handoffs and three nursing handoffs per day, multiplied by four for the average length of stay, equals at least 20 handoffs. “And that is likely a conservative estimate,” he said.
Physicians “don't know any systematic way to do this,” said Dr. Shorr, associate section director of pulmonary critical care, Washington (D.C.) Hospital Center, and a member of the medicine faculty at Georgetown University.
The complexity of ICU care is one challenge: In a study, a checklist developed by surgeons worked well for handoffs in all hospital settings except critical care (J. Surg. Educ. 2008;65:476–85).
The noise level and degree of privacy also can play a role. “If this is in a busy cafeteria while someone is grabbing coffee and about to leave, [the handoff] is probably not going to go well,” Dr. Shorr said.
Moreover, there is no standard definition of an effective handoff, he said. A handoff should involve interactive, up-to-date communication that employs repeat and read-back techniques, according to the Joint Commission's National Patient Safety Goals. “I've never seen that in the ICU,” he said.
In addition, about one-third of malpractice claim reviews involve communication errors, and 40% of those refer to patient handoffs, Dr. Shorr said. A prospective study is needed to determine the most effective system for handoffs in the critical care setting, he said.
Disclosures: Dr. Shore had no relevant financial relationships.
MIAMI BEACH — Most critical care patients experience at least 20 “handoffs” during their average 4-day hospital stay—handoffs that are “major opportunities for miscommunication” that can lead to errors, Dr. Andrew Shorr said.
“These handoffs happen routinely, and we have little published evidence about them…. If this were going to be an evidence-based talk, I could sit down right now,” he said at the annual congress of the Society of Critical Care Medicine.
He calculated the scope of the ICU problem as follows: two physician handoffs and three nursing handoffs per day, multiplied by four for the average length of stay, equals at least 20 handoffs. “And that is likely a conservative estimate,” he said.
Physicians “don't know any systematic way to do this,” said Dr. Shorr, associate section director of pulmonary critical care, Washington (D.C.) Hospital Center, and a member of the medicine faculty at Georgetown University.
The complexity of ICU care is one challenge: In a study, a checklist developed by surgeons worked well for handoffs in all hospital settings except critical care (J. Surg. Educ. 2008;65:476–85).
The noise level and degree of privacy also can play a role. “If this is in a busy cafeteria while someone is grabbing coffee and about to leave, [the handoff] is probably not going to go well,” Dr. Shorr said.
Moreover, there is no standard definition of an effective handoff, he said. A handoff should involve interactive, up-to-date communication that employs repeat and read-back techniques, according to the Joint Commission's National Patient Safety Goals. “I've never seen that in the ICU,” he said.
In addition, about one-third of malpractice claim reviews involve communication errors, and 40% of those refer to patient handoffs, Dr. Shorr said. A prospective study is needed to determine the most effective system for handoffs in the critical care setting, he said.
Disclosures: Dr. Shore had no relevant financial relationships.
MIAMI BEACH — Most critical care patients experience at least 20 “handoffs” during their average 4-day hospital stay—handoffs that are “major opportunities for miscommunication” that can lead to errors, Dr. Andrew Shorr said.
“These handoffs happen routinely, and we have little published evidence about them…. If this were going to be an evidence-based talk, I could sit down right now,” he said at the annual congress of the Society of Critical Care Medicine.
He calculated the scope of the ICU problem as follows: two physician handoffs and three nursing handoffs per day, multiplied by four for the average length of stay, equals at least 20 handoffs. “And that is likely a conservative estimate,” he said.
Physicians “don't know any systematic way to do this,” said Dr. Shorr, associate section director of pulmonary critical care, Washington (D.C.) Hospital Center, and a member of the medicine faculty at Georgetown University.
The complexity of ICU care is one challenge: In a study, a checklist developed by surgeons worked well for handoffs in all hospital settings except critical care (J. Surg. Educ. 2008;65:476–85).
The noise level and degree of privacy also can play a role. “If this is in a busy cafeteria while someone is grabbing coffee and about to leave, [the handoff] is probably not going to go well,” Dr. Shorr said.
Moreover, there is no standard definition of an effective handoff, he said. A handoff should involve interactive, up-to-date communication that employs repeat and read-back techniques, according to the Joint Commission's National Patient Safety Goals. “I've never seen that in the ICU,” he said.
In addition, about one-third of malpractice claim reviews involve communication errors, and 40% of those refer to patient handoffs, Dr. Shorr said. A prospective study is needed to determine the most effective system for handoffs in the critical care setting, he said.
Disclosures: Dr. Shore had no relevant financial relationships.