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Better Communication Among Caregivers Reduces Medical Errors, Authors Find

Preventable adverse events cut by 30%

A method of handing off information about pediatric patients when residents change shifts reduced preventable adverse events by 30%, a new study has found.

The study, led by Boston Children’s Hospital, tested the effects of a standardized method for medical residents to hand off information about their patients at shift changes in nine U.S. children’s hospitals. Shorter shifts for residents have increased the number of such handoffs, prompting increased scrutiny of what happens during them.

“This focus is not unique to medicine,” said co-author Lauren Destino, MD. The link between handoff communication and safety has been demonstrated in industries such as nuclear power, emergency medical services, and airlines, she said.

The study was published in the New England Journal of Medicine.

At each participating hospital in the study, medical residents were trained to use an acronym that reminded them what information to share about each patient, and in what order. The handoff process included both oral and written communications, and ended with the person who was receiving the information repeating back a summary of what was shared with the person who gave it. The program also included other supports to ensure that the handoff procedure was embedded in the hospital’s culture and did not have a negative effect on the doctors’ overall workflow. The study’s primary outcome had two components: medical errors and preventable adverse events (AEs).

In 10,740 patient admissions, the medical error rate decreased by 23% from the pre-intervention period to the post-intervention period (24.5 vs. 18.8 per 100 admissions; P < 0.001), and the rate of preventable AEs decreased by 30% (4.7 vs. 3.3 events per 100 admissions; P < 0.001). The rate of non-preventable AEs 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 the nine sites.

“We decreased preventable adverse events by 30%, but there was no change in non-preventable events,” Destino said. “That suggests that it was the improved handoffs themselves that led to the reduction in errors.” If both preventable and non-preventable errors had dropped, that might have suggested that the hospitals were seeing healthier or lower-risk patients at the end of the study, she explained.

“It's tremendously exciting to finally have a comprehensive and rigorously tested training program that has been proven to be associated with safer care and that meets this need for our patients,” said lead author Amy Starmer, MD.

Sources: Medical Xpress; December 8, 2014; NEJM; November 14, 2014; and I-PASS Materials; 2014.


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