Web-Based Tool Helps Slash Hospital’s Patient Handoff Errors
EMS-to-ED patient handovers are perilous moments, and so are handovers within hospitals—that is, at shift change, when offgoing and possibly fatigued clinicians bequeath patient care to their successors. A study at Boston’s Brigham and Women’s Hospital found that using a web-based handoff tool may help reduce those errors.
The tool scanned patients’ electronic medical records for key information it then extracted into separate highlight documents for oncoming caregivers. These helped produce a dramatic cut in avoidable medical errors.
To test the tool, investigators surveyed residents at the end of their shifts about possible mistakes, then rated those mistakes for avoidability. After three months they introduced the tool (along with an educational component), then compared error rates before and after. The number of mistakes was slashed: From November 2012 to February 2013 they identified 77 errors; in the subsequent year just 45. The project was described in JAMA Internal Medicine,1 and Brigham and Women’s has now integrated the tool into its commercially produced EHR.
In a commentary with that article, patient safety expert Robert Wachter noted that web-based handoff tools had the potential to improve patient safety and hospital workflow but had to be “carefully built and integrated into existing systems.”2 And that brings us to us: Could such a tool be extended to EMS and work similarly to help avert transition mistakes?
EMS/hospital data exchange is overall still pretty limited. The NAEMT’s 2016 National Survey: Data Collection, Use and Exchange in EMS found just 66% of respondents were electronically transmitting ePCRs to receiving facilities. Just 23% were getting outcomes data back.
But there could be potential.
“While no single tool will be a perfect fit for all environments, a communication aid such as the one used at Brigham and Women’s could surely benefit EMS handoffs at the emergency department,” says EMS educator Rommie Duckworth, who proposes a new patient-handoff mnemonic in November’s EMS World. “Such a tool addresses the S’s of the EEESS format. For reporting EMS providers this would help standardize the structured report, focusing attention by prioritizing critical items when the provider supplies documentation details. Likewise, this kind of tool can help receiving staff summarize the supplied documentation, allowing for EMS to correct any errors of understanding and ensure that hospital personnel have a shared understanding (mental model) of the priority patient issues.”
References
1. Mueller SK, Yoon C, Schnipper JL. Association of a Web-Based Handoff Tool With Rates of Medical Errors. JAMA Intern Med, 2016 Sep 1; 176(9): 1,400–2.
2. Schoenfeld AJ, Wachter RM. The Search for Better Patient Handoff Tools. JAMA Intern Med, 2016 Sep 1; 176(9): 1,402–3.
