If you’ve ever watched a relay race at a track meet, you know how crucial hand offs can be. Drop the baton and you’ve significantly altered your chance for a good outcome. But in a track meet, lives aren’t on the line and you don’t have anxious patients depending on you. In healthcare, both clinical outcomes and the patient experience hinge on good hand offs.
It goes without saying that a smooth handoff is imperative for the clinical staff. In order to deliver the best care, you need to know what has transpired – what treatments have been administered and a summary of the patient’s condition as well as anticipated next steps. Clinicians want to know about any past concerns and who to contact should issues arise. But the clinical team isn’t the only party that benefits from a well-orchestrated hand off. Patients and families benefit too.
I was recently in a patient room when he was brought back to the inpatient unit from surgery. The family had several questions for the surgical nurse accompanying the patient back to the unit. She patiently and thoroughly answered their questions. They had been told that the patient was severely nauseated and vomiting in recovery and had been given an IV dose of an anti-nausea medication. During that discussion, the receiving nurse was in and out of the room. Not 10 minutes later, the unit nurse came in and said she was going to give the patient something for nausea. The patient told her that he had already gotten something and the family confirmed it. The nurse, syringe in hand, seemed surprised and said she’d check. Of course she learned that the medication had been administered in recovery. She let the patient and family know that she had confirmed the medication was already given.
Imagine what that does for the patient and family’s trust! Now, chances are good, they will be questioning everything.
Patients need to be able to trust that staff are communicating with one another with their best interest at heart. A patient should never be left wondering if the left hand knows what the right hand is doing. One of the most effective and reassuring ways to do hand offs is during bedside shift report. Why? Because the patient witnesses the hand off and, when done well, becomes a part of the hand off discussion. They hear a summary of their condition and treatments and know their story has been shared.
When we shadow bedside shift reports, the most commonly missed opportunity is that of engaging the patient in the discussion. This small, but significant part of the hand off allows them to share additional pieces of information that they would like relayed.
Becoming a high-reliability organization requires that hand offs are managed well. Remember – when one thing erodes the patient’s trust, it’s hard to recover.