Safer Patient Handoffs

Distractions During Ambulatory Surgery Center Patient Handoffs May Put Patients At Risk

July 2015


New research published in the Clinical Anesthesiology section of the July 2015 edition of Anesthesiology News finds that when patient handoff communications in ambulatory surgery centers (ASCs) are interrupted, they are associated with more errors. The investigators also estimate that some 50 percent of the interruptions observed might have been avoidable.

A good number of reports have been published in the literature about the risk that communication failures pose in operating rooms in US hospitals. In particular, the benefit of standardizing process, guided by checklists, has been a topic of immense discussion, both in the patient safety literature and in the discourse of patient safety experts.

Moreover, the clinical and administrative managers of hospital surgical service lines are increasingly examining opportunities to implement process standardization to improve surgical patient safety and reduce the incidence of so called ‘surgical never events.’

Sign outs or patient handoffs have garnered a similar level of attention as they can adversely impact care continuity and patient safety. A good bit of evidence in the literature has shown that handovers between medical providers are a significant opportunity for communication failures which lead to medical errors and adverse events.

A recent report from several clinical investigators at Cooper Medical School of Rowan University in Camden, New Jersey appearing in the July 2015 edition of Anesthesiology News presents findings from a clinical research effort which examined patient handoffs and sign outs in the ASC setting.

Investigators retrospectively examined audio recordings from some 80 patient handoffs over a six-week period. The handoffs were reviewed by trained observers, which determined the length of each handoff, the quality of information exchange and the incidence of distractions. The investigators also surveyed the ‘sending’ and ‘receiving’ clinicians to elicit information about their satisfaction with each handover interaction.

The study found that some 40 percent of the handovers were plagued by distractions and that when this occurred, the handoffs i) took longer (p < 0.001), ii) were of poorer quality (p < 0.05), and iii) were more likely to include the transmission of erroneous information. In addition, the ‘sender’ survey respondents reported lower satisfaction scores when the handovers were interrupted (p < 0.05).

Interestingly, the leading causes of distractions in the study were equipment issues and monitor alarms, which were the cause of 19 percent of the sign-out interruptions. The next largest sources of distractions included patient care and transient patient and staff communication. The researchers estimate that some 50 percent of the interruptions they observed may have been preventable.

The researchers also report several instances where handover times were impaired by the absence of a staff member to ‘receive’ sign-out which often necessitated that the anesthesia staff wait several minutes for a nurse that could receive report. They suggest that eliminating the frequency of this phenomenon may provide an opportunity to further improve ASC surgical case throughput by reducing the turnaround or turnover time between cases.

Ultimately, the researchers state that further research on the topic of handovers in healthcare, including handoffs at ASCs, has strong potential to provide new insights that could lead to improvements in both operational efficiency and patient safety.