Author(s): Amy J Starmer, Nancy D Spector, Rajendu Srivastava, Daniel C West, Glenn Rosenbluth
BACKGROUND Miscommunications are a leading cause of serious medical errors. Data from mul - ticenter studies assessing programs designed to improve handoff of information about patient care are lacking.
METHODS We conducted a prospective intervention study of a resident handoff-improvement program in nine hospitals, measuring rates of medical errors, preventable adverse events, and miscommunications, as well as resident workf low. The intervention included a mnemonic to standardize oral and written handoffs, handoff and com - munication training, a faculty development and observation program, and a sus - tainability campaign. Error rates were measured through active surveillance. Hand - offs were assessed by means of evaluation of printed handoff documents and audio recordings. Workf low was assessed through time–motion observations. The primary outcome had two components: medical errors and preventable adverse events.
RESULTS In 10,740 patient admissions, the medical-error rate decreased by 23% from the preintervention period to the postintervention period (24.5 vs. 18.8 per 100 admis - sions, P<0.001), and the rate of preventable adverse events decreased by 30% (4.7 vs. 3.3 events per 100 admissions, P<0.001). The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P = 0.79). Site- level analyses showed significant error reductions at six of nine sites. Across sites, significant increases were observed in the inclusion of all prespecified key elements in written documents and oral communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There were no significant changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively; P = 0.55) or in resident workf low, including patient–family contact and computer time.
CONCLUSIONS Implementation of the handoff program was associated with reductions in medi - cal errors and in preventable adverse events and with improvements in communi - cation, without a negative effect on workf low. (Funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Ser - vices, and others.Journal of Anesthesia & Clinical Research