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You are on call for the General Wards service, and it's late in the afternoon. One of your co-interns, Dr George, went home a few hours ago. He sent you a text page telling you that a list of his patients is taped to the door of the resident's lounge and that “every one is stable.” As you were busy admitting a sick patient when you got his text, you did not have time to call Dr George back and ask for more detailed information.

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Just as you are getting ready to eat supper, you get a page from a nurse. He tells you that one of Dr George's patients is in respiratory distress and needs to be assessed. This patient is not on the list that Dr George printed out for you, but when you check the patient's chart, you see that he has been seeing and writing notes on the patient daily. Unfortunately, his note in her chart from today is largely illegible. When you go to the patient's room to assess her and begin asking questions, the patient becomes irritated. “I already answered these questions a million times! Don't you people talk to each other?”

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1. What are the communication challenges present in this scenario?

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2. How can a handoff process be structured in order to mitigate the communication breakdowns present in the above case?

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Answers

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  1. In the above scenario, there are many opportunities for improvement in communication of handoff information. First, and perhaps most importantly, the handoff does not occur in a face-to-face fashion. Since the giving and the receiving interns do not meet and discuss the patients, the only information shared is a list of names and the vague panacea that all patients are “stable.” Because there is not an appointed time and place for the handoff to occur, the list ends up being posted in a potentially public area, and the receiving intern is too distracted by a new patient to be able to take the time to ask Dr George important questions about the patients on his service. Lastly, the list of patients to cover is incorrect, leading to additional time spent by the covering intern gathering facts from the patient and chart, which is illegible. The patient's perception that this is a poor way to approach patient care is correct.

  2. Although the focus on skills for successful transfers of care is relatively new, there are best practices advocated for and supported by a growing body of medical literature. It is important that your residency program provides a consistent structure for handoffs. A specific time and place for handoff, consistent written and verbal formats, content guidelines, and an insistence on legible, accurate charting should be strong elements of the resident culture around transfers of patient information and care. These items should be perceived as mandatory ...

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