Over the past 25 years since I have practiced nephrology one thing that seems to have changed for the worse is the fragmentation of care. In a typical academic medical center, hand-offs represent one of the largest sources of fragmentation and discontinuity. There are a multitude of potential hand-offs: one team handing a patient over to another, the internist handing off to the hospitalist or nocturnalist (and back), the "night-float" resident to the day time shift resident, and from weekday to weekend hand-off's. The number of hand-offs that might occur in a patient’s stay in the hospital can be quite astounding.
I came across a blog piece by Mathew Weinstock in Hospitals and Health Networks (H&HN) that reinforces the notion that hand-off’s can lead to worse outcomes. Writes Weinstock:
“The Joint Commission estimates that 80 percent of serious medical errors involve miscommunication between caregivers when a patient is handed off or transferred between care settings. Miscommunication was also the leading root cause of sentinel events reported to the commission between 1995 and 2006. That's partly why the Joint Commission's Center for Transforming Healthcare initiated a project aimed at helping hospitals improve transitions of care.”
Digging more deeply into the issue of hand-off’s I came across a really terrific article by Lee Ann Runy (also in H&HN) that is definitely worth a read because it provides pragmatic recommendations about improving the hand-off. There is also a terrific powerpoint presentation on hand-off's that's worth looking at.
The bottom-line is that bad hand-off’s lead to medical errors and whether we like it or not doing a good hand-off is now a part of being a doctor!