BOSTON (Dec. 3, 2013) — Boston Children’s Hospital is a national leader for research into optimizing patient safety and reducing medical errors, which are widespread in U.S. medical centers.1 A new study from Boston Children's Division of General Pediatrics—published online Dec. 3 by the Journal of the American Medical Association (JAMA)—indicates that improving verbal and written communication during patient handoffs can reduce medical errors substantially without burdening existing workflows.
Medical errors are a leading cause of death and injury in the U.S., with an estimated 80 percent of serious medical errors involving some form of miscommunication, particularly when care is transferred in a hospital setting from one provider to the next.
"By introducing more standardized communication during patient handoffs for this study, Boston Children’s saw a substantial drop in the overall number of medical errors," says the study's principal investigator Christopher Landrigan, MD, MPH.
"We believe if other medical centers adopted similar protocols it could have a positive and significant impact on patient safety."
Error types included those with little or no potential for harm, intercepted potential adverse events, non-intercepted potential adverse events and preventable adverse events. Preventable adverse events decreased from 3.3 per 100 admissions to 1.5 per 100 admissions following intervention.
With the goal of improving provider-to-provider communication, Landrigan and Amy Starmer, MD, MPH, lead author of the study, designed a multi-faceted, bundled handoff system consisting of three key components: standardized communication and handoff training, a verbal mnemonic and a new team handoff structure.
"Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan, but though vital to patient care, rarely receive communication or handoff training,” says Starmer. "We sought to rectify that omission with this study.”
The researchers examined 1,255 patient admissions that occurred during the implementation of the handoff bundle to measure how it impacted patient care and clinician workflow across two separate inpatient units at Boston Children's.
Implementation of the new system began with an interactive workshop for all participating clinicians, during which they practiced giving and receiving handoffs under different clinical and real-world scenarios. The workshop was based on best practices for handoffs using elements of the TeamSTEPPS communication program, developed by the military and the U.S. Agency for Healthcare Research and Quality.
Secondly, participants adopted an easy-to-remember mnemonic to ensure all relevant information was verbally communicated during the handoff. Face-to-face handoffs were also restructured to involve all team members and minimize interruptions and distractions.
Finally, in conjunction with Boston Children's informatics team, the researchers created a structured handoff tool within the electronic medical record (EMR) to standardize the documentation of patient information that is transmitted at change of shift. The electronic handoff tool self-populates with standard patient information. This replaced the previous method of information exchange that required clinicians to manually enter and re-enter information in a word processing document, increasing the potential for human error.
After implementation of the communication bundle there were fewer omissions or miscommunications about important data during handoffs, which led to positive results. Of the 1,255 patient admissions studied, medical errors decreased 45.8 percent. In addition, following the intervention, providers spent more time communicating face-to-face in quiet areas conducive to conversation, and spent more time at the bedside with patients.
"We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude," Starmer says. "And even more surprising was that the systems were introduced so easily. Participants embraced the new systems, became more productive, and could then focus more energy to the job at hand."
Based on the results of this study, Landrigan and team developed I-PASS, a handoff bundle rolling out to 10 teaching hospitals across North America.
“Our ultimate goal,” says Landrigan, “is to develop a robust handoff program that can be broadly disseminated across hospitals and specialties to reduce medical errors and optimize patient safety.”
1 In 2001, JAMA published data from a ground-breaking Boston Children’s study, one of the first studies to rigorously measure the prevalence of error rates in hospitals. (Kaushal R, Bates DW, Landrigan C, et al. Medication Errors and Adverse Drug Events in Pediatric Inpatients. JAMA.2001;285(16):2114-2120. doi:10.1001/jama.285.16.2114.)
About Boston Children's Hospital
Boston Children’s Hospital is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 13 members of the Institute of Medicine and 14 members of the Howard Hughes Medical Institute comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s today is a 395-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Boston Children’s is also the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Boston Children’s, visit: http://vectorblog.org.
Meghan Weber, Boston Children’s Hospital
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