Better Provider Hand-offs Equal Safer Patient Care
One of the most prevailing causes of adverse events in hospitals today is the failure between caregivers to communicate effectively about their patients’ care. By its very nature, the hospital environment is extremely complex, multi-task-oriented, fast-paced and highly stressful Individuals who work in this environment are barraged by constant interruptions and distractions which challenges their ability to ensure continuity of care is not compromised. Because much of the care delivery process is heavily dependant upon verbal communication about patients as they are handed off between shifts, units, other caregivers and facilities, the challenges are even greater.
Verbal hand-offs between individuals requires that both the sender and the receiver articulate and hear what is being communicated so that things like pending or important test results and other key information isn’t inadvertently missed . Equally as important is the ability for nurses or support staff to effectively convey concerns to physicians about a patient’s condition especially in situations where the patient’s condition appears critical.
Communication breakdowns typically fall into one of three categories: inadequate hand-offs or personnel changes; nurse to physician communication in which the nurse is unable to get the physician’s attention about a patient’s condition; and failure to establish clear lines of responsibility in a critical situation. These breakdowns occur because of the hierarchy that naturally exists in healthcare and the lack of structured and defined standards for how to communicate effectively, when to communicate, and what information to include. Unfortunately, if the stage is not set for collaborative practice and good team communication, important pieces of information about a patient may not be shared.
When SVMC began its work several years ago to address communication failures, there was a distinct disconnect in nurse and physician communication styles. Nurses are trained to be narrative and descriptive; physicians are trained to be problem solvers and look for key headlines or salient points. Like many hospitals across the nation, SVMC has challenged to put a structured process in place to bring these groups together. SVMC adopted a tool known as SBAR as the standardized approach for all communication. SBAR stands for Situation (current issue at hand); Background (key clinical information about the patient); Assessment (what the specific concern is) and Recommendation (what, specifically, is needed). The purpose of SBAR is to structure the conversation so that clear information about a patient’s care, treatment and services, current condition and any recent or anticipated changes are communicated to ensure the continuity and safety of a patient’s care.
Although SVMC instituted SBAR several years ago, it was not consistently nor effectively applied in all settings. Different departments used varying adaptations of the approach which led to inadequate handoffs, failures in RN-MD communication and unclear lines of responsibility in critical situations. In early 2010, SVMC instituted a policy whereby every clinical department, service or agency must implement a process utilizing SBAR for all hand-offs and critical communication between care givers regarding a patient’s care. This includes shift-to-shift, unit-to-unit or service-to service communication, physician sign-outs to covering physicians, and communication between the hospital and other facilities.
Having a standardized format allows all parties to have common expectations about what is to be communicated, how the communication is to be structured, and what the required elements are. Widespread education is now underway to teach the methodology as well as the tools and techniques for effective assertion. SVMC will monitor the effectiveness of its revised policies and education of staff by looking at results of its annual Safety Climate Survey in which caregivers will be asked to rate their own experiences with hand-off communication. SVMC will also look at data on things like incorrect treatments, delays in diagnosis or patient complaints to look for instances where key information may have been missed. These events will be tallied and compared with historical data to determine effectiveness of SVMC’s renewed focus on improving transitions in care for patients.