Featured Research

from universities, journals, and other organizations

Communication often fumbled during patient hand-offs in hospital

Date:
March 13, 2010
Source:
University of Chicago Medical Center
Summary:
As shifts change in a hospital, outgoing physicians must "hand off" important information to their replacements in a brief meeting. But a new study of this hand-off process finds that the most important information is not fully conveyed in a majority of cases, even as physicians rate their communication as successful.

As shifts change in a hospital, outgoing physicians must "hand off" important information to their replacements in a brief meeting. But a new study of this hand-off process finds that the most important information is not fully conveyed in a majority of cases, even as physicians rate their communication as successful.

Related Articles


The research, published by University of Chicago researchers in the March issue of Pediatrics, highlights the importance of educating doctors about successful communication skills during hand-offs. The results also emphasize the risk inherent in increased hand-offs necessitated by restrictions on medical resident work hours, even as further work limits are being discussed.

"When resident hours are shortened, you have more hand-offs," said Vineet Arora, MD, assistant professor of medicine at the University of Chicago Medical Center. "You could have concerns about either a tired physician who knows the patient or a well-rested physician that may not know the patient. The tradeoff is between fatigue and familiarity."

Conducted through a unique collaboration between physicians and psychologists at the University of Chicago, the study observed hand-off communication between pediatric interns -- first-year residents -- at Comer Children's Hospital at the University of Chicago. Interns at the end of an overnight shift would spend a total of 10-15 minutes sharing information about hospitalized patients with the resident relieving them in a designated hand-off room.

Both the outgoing and incoming interns were then asked by researchers about what they thought was the most important information conveyed during the hand-off about each patient. Surprisingly, what the outgoing intern identified as the most important information was not successfully communicated to the incoming intern 60 percent of the time. The rationale for certain medical decisions -- such as why a patient is on a particular drug or why the primary care physician should be contacted -- was also not understood by the receiving intern in a majority of cases.

But despite these miscommunications, interns on both sides of the hand-off consistently rated the quality of their communication as very high. Boaz Keysar, PhD, a professor of psychology at the University of Chicago and co- author of the paper, said that this disconnect between perceived and actual success of communication is common in other settings.

"You would imagine the kind of miscommunication we discover elsewhere actually might be reduced when the stakes are high in a clinical setting, because it matters so much," Keysar said. "But the opposite is true, which I think is counter-intuitive and important to know."

The results were even more striking given the optimal hand-off conditions for interns at Comer Children's Hospital. In each hand-off, a conversation takes place in a designated room under supervision by more experienced physicians. In previous research, Arora found that many hospitals and programs have much less organized hand-off procedures -- if they occur at all.

In illustrating the communication breakdowns that plague even best-case hand-off conditions, Arora and Keysar hope to inform medical centers and schools of the need for better education about hand-offs. The study found that "anticipatory guidance" -- offering to-do items or if-then advice -- was a more effective way of communicating information between interns than passing on knowledge items in bulk. Currently, Arora and colleagues are working on a simulation exercise for fourth-year medical students to train more effective hand-off communication skills.

Such training, they hope, will be more effective than relying upon computer programs and electronic medical records to facilitate hand-off communication. A verbal exchange of information remains important so that young doctors can make quick, informed decisions about patients, Arora said.

"IT solutions cannot substitute for a successful communication act," Arora said. "We aren't at the point where computers are going to do that for us. Technology solutions can help so that you have the information that you need when you need it, but to look at that information and be able to make a judgment about what to do, that is what the hand-off conversation is for."

But while researchers look for the best way to improve those conversations, Arora and Keysar hope that medical policymakers are aware of the risks inherent in the current hand-off model. As the Accreditation Council for General Medical Education ponders further restrictions upon the number of hours residents and interns can work, the consequences of those reduced hours must be acknowledged, they said.

"We tend to be very myopic in the way we think about this problem," Keysar said. "Reducing hours is good, but there's a cost that is not obvious at all, and this study really spells that cost out. It's very difficult for us to gauge how well we are understood, and this should be taken into account in the trade-off between number of work hours and fatigue."


Story Source:

The above story is based on materials provided by University of Chicago Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. Chang et al. Interns Overestimate the Effectiveness of Their Hand-off Communication. Pediatrics, 2010; 125 (3): 491 DOI: 10.1542/peds.2009-0351

Cite This Page:

University of Chicago Medical Center. "Communication often fumbled during patient hand-offs in hospital." ScienceDaily. ScienceDaily, 13 March 2010. <www.sciencedaily.com/releases/2010/03/100311091611.htm>.
University of Chicago Medical Center. (2010, March 13). Communication often fumbled during patient hand-offs in hospital. ScienceDaily. Retrieved November 27, 2014 from www.sciencedaily.com/releases/2010/03/100311091611.htm
University of Chicago Medical Center. "Communication often fumbled during patient hand-offs in hospital." ScienceDaily. www.sciencedaily.com/releases/2010/03/100311091611.htm (accessed November 27, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, November 27, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Pet Dogs to Be Used in Anti-Ageing Trial

Pet Dogs to Be Used in Anti-Ageing Trial

Reuters - Innovations Video Online (Nov. 26, 2014) Researchers in the United States are preparing to discover whether a drug commonly used in human organ transplants can extend the lifespan and health quality of pet dogs. Video provided by Reuters
Powered by NewsLook.com
Today's Prostheses Are More Capable Than Ever

Today's Prostheses Are More Capable Than Ever

Newsy (Nov. 26, 2014) Advances in prosthetics are making replacement body parts stronger and more lifelike than they’ve ever been. Video provided by Newsy
Powered by NewsLook.com
From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

Newsy (Nov. 25, 2014) The US FDA is announcing new calorie rules on Tuesday that will require everywhere from theaters to vending machines to include calorie counts. Video provided by Newsy
Powered by NewsLook.com
Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Newsy (Nov. 25, 2014) Need another reason to eat yogurt every day? Researchers now say it could reduce a person's risk of developing type 2 diabetes. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins