Medical errors are one of the most pressing problems that health care workers have to solve at the present stage of development. The patient safety approach demands to provide high-quality services and treatment and reduce the number of errors that occur in the medical environment. There is no doubt that nurses should be aware of the latest achievements in this sphere and pay attention to the recent research findings.
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Handoff or handover miscommunication as one of the main causes of medical errors has become the object of interest. Many researchers address this issue since health care professionals have to deal with this matter on a daily basis. For instance, handovers among nurses are frequent: they occur between shifts, among part-time nurses, and during direct communication with other specialists (Lee, Phan, Dorman, Weaver, & Pronovost, 2016). It is believed that hospital handoffs are the key locus of communication breakdown and patient safety and quality of care reduction (Cohen, Hilligoss, & Amaral, 2012). According to statistics, 80% of serious medical errors all over the globe take place because of miscommunication (Mujumdar & Santos, 2014). Thus, it is vital to focus on handoff communication enhancement.
The present paper examines the study concerning the implementation of a resident handoff bundle as a possible solution to the problem of medical errors and preventable adverse events in hospitalized children (Starmer et al., 2013). The main points of the article, namely the background of the study, methods, and findings, are examined. Further, ethical issues are assessed. Finally, the conclusion about the relevance of the study for nurses is drawn.
The researchers explore the present-day tendencies in relation to medical communication errors. They emphasize that, despite the new requirements promoted by the Agency for Healthcare Research and Quality (AHQR) and the Accreditation Council for Graduate Medical Education, some institutions lack sustainable procedures for ensuring appropriate handovers (Starmer et al., 2013). Consequently, the problem of handoff communication enhancement should be studied in order to educate staff and guarantee patent safety. Working in shifts, nurses provide patients with care and act as coordinators among different health care specialists. As a result, a patient is supervised by several staff members who need to communicate and obtain up-to-date information.
The purpose of the study is to create a handoff bundle and combine several handoff interventions: general communication training, mnemonics, the paraphrase of verbal handovers, engagement of all team members, and written or computerized tools (Starmer et al., 2013). In this respect, the research question is whether the multifaceted handover program is connected with lower percentages of medical errors, data skipping, and information gaps. The researchers want to know if the suggested program is associated with better oral professional communication and working process enhancement.
As for the concepts and phenomena, the researchers do not put emphasis on them. However, one can understand that the main phenomenon in the context of the study is the corruption of information. To put it bluntly, people tend to misrepresent data in any sphere, including their professional activity. As a result, specific measures to discover the truth are needed.
The present research is an example of a quantitative study. As the authors state, they carried out a prospective intervention study on two general inpatient pediatric units: 1255 patient admissions (642 before and 613 after the intervention) at Boston Children’s Hospital were studied, and 84 resident doctors (42 before and 42 after the intervention) were involved (Starmer et al., 2013). The medical staff members consisted of interns and senior residents educated about the peculiarities of handovers.
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Resident physicians were to implement the new handoff model, including the bundle elements in their practice, when exercising control over the selected units. The researchers provide information about the organization within the study units: day-shift teams included one senior resident and three interns for each unit, and night-shift teams embraced one intern for a unit and one senior resident who was responsible for both units. The first unit covered general pediatric and subspecialty patients; general pediatric and complex care service patients were treated in the second unit (Starmer et al., 2013).
As for the procedures, it is asserted that the educative and system-based handover intervention was present. The resident handoff bundle included two hours of hands-on training that pertained to the program developed by AHRQ and the US Department of Defense, verbal mnemonic devices, and the changes in the teamwork organization. Besides, computer-based handover tools connected with the electronic health records were exploited in one unit. To assess how residents managed workflow and verbal handoffs, the researchers held time-motion observation sessions; proportions for dichotomous variables, means for continuous variables, and error indexes were collated using Poisson regression, with a dichotomous covariate for before vs. after the intervention period (Starmer et al., 2013).
After the intervention was introduced, the level of medical errors and preventable adverse events grew less to a significant extent: the former indicator declined from 33.8 per 100 patient admissions to 18.3 while the latter changed from 3.3 per 100 admissions to 1.5. According to the article, the intervention brought positive results in terms of printed handoff documents: the number of omissions of essential handoff components decreased. The usage of the computerized tool was associated with impressive results: reductions of omissions in 11 of 14 categories were registered with the computerized tool; comparably, 2 of 14 categories without computerized tool changed for the better (Starmer et al., 2013).
Another outcome of the study touched upon the average amount of time that health care specialists spent at the patient bedside. After the intervention, these rates increased from 8.3% to 10.6%. The medium time spent on verbal handoffs per patient remained the same, but staff members started choosing quiet places to communicate.
These results are important for nurses. As a part of a team, they should understand how handoff errors may be reduced and act correspondingly. The proper usage of written and computerized tools and communication in a private and calm setting, some of the most effective behavior patterns, are what nurses can do in their practice. The findings also affect nursing knowledge: if nurses obtain theoretical information based on these findings, they will commonly use it and do it more successfully.
The research was carried out by the approbation of the Boston Children’s Hospital institutional review board. Direct observational and survey data were gathered from those who provided written informed consent (Starmer et al., 2013). Only the researchers had access to the participants’ demographic characteristics, and this information was used for the sole purpose of research. No ethical considerations regarding the treatment or lack of it are described.
To sum up, medical errors and patient safety remain important. In the present study, the resident handoff bundle is suggested as one of the possible measures. This research may be useful for nurses because they can directly make use of the elements of the intervention in their practice.
Cohen, M. D., Hilligoss, B., & Amaral, A. C. K. B. (2012). A handoff is not a telegram: An understanding of the patient is co-constructed. Critical Care, 16(1), 303-311.
Lee, S. H., Phan, P. H., Dorman, T., Weaver, S. J., & Pronovost, P. J. (2016). Handoffs, safety culture, and practices: Evidence from the hospital survey on patient safety culture. BMC Health Services Research, 16(1), 254-267.
Mujumdar, S., & Santos, D. (2014). Teamwork and communication: An effective approach to patient safety. HMA, 50(1), 19-22.
Starmer, A. J., Sectish, T. C., Simon, D. W., Keohane, C., McSweeney, M. E., Chung, E. Y.,… & Landrigan, C. P. (2013). Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. Jama, 310(21), 2262-2270.