August 15, 2016
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Web-based communication tool, training associated with less medical errors

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A web-based tool and health care professional training improved communication during patient handoffs and reduced medical errors, according to data published in JAMA Internal Medicine.

"Communication among health care personnel is vulnerable to error during patient handoffs (ie, the transfer of responsibility for patient care between health care professionals)," Stephanie K. Mueller, MD, MPH, from the division of general internal medicine at Brigham and Women's Hospital, and colleagues wrote. "Handoffs occur with high frequency in the hospital and have been increasing following restrictions of resident work hours. However, to our knowledge, there remains a lack of rigorously performed studies that help guide best practices in handoffs of hospitalized adult patients."

Mueller and colleagues conducted a prospective cohort analysis of 5,407 patients treated at Brigham and Women's Hospital on general medicine or general surgery services. The study included data collection before implementing the tool, after implementing the tool and a period after implementing the tool that matched pre-implementation by time of year.

The handoff tool included: "auto-population of patient information from the existing electronic medical record; templated fields that directed users to include key pieces of clinical information; and merging of workflow such that users updated components of the handoff and progress notes simultaneously." Health care providers also received training on the tool, as well as communication, teamwork and handoff skills.

They found that the handoff tool and training was associated with a significant reduction in medical errors which were primarily attributed to communication failure and poor end-of-shift handoffs.

Results showed that 77 medical errors were identified before implementation of the tool and 45 were identified after.

Mueller and colleagues calculated decreases from before the intervention to after in:

  • total medical error rates per 100 patient-days: 3.56 (95% CI, 1.7-7.44) vs. 1.76 (95% CI, 0.93-3.31);
  • errors due to communication failure: 2.88 (95% CI, 1.22-6.82) vs. 1.15 (95% CI, 0.76-1.74);
  • errors due to handoff mistakes: 2.47 (95% CI, 1-6.07) vs. 0.95 (95% CI, 0.56-1.61);
  • errors due to end-of-shift handoffs: 6.93 (95% CI, 5.36-8.76) vs. 3.59 (95% CI, 2.55-4.87);
  • errors on medical services: 3.18 (95% CI, 2.45-4.05) vs. 1.3 (95% CI, 0.85-1.87); and
  • errors on surgical services: 13.11 (95% CI, 7.69-20.63) vs. 5.45 (95% CI, 3.4-8.2).

"Our findings suggest that implementation of a web-based handoff tool and training for health care professionals is associated with fewer medical errors, particularly those owing to communication failures," Mueller and colleagues concluded. "In addition, our intervention appeared synergistic (or additive) with concurrent care team regionalization, suggesting effectiveness in a real-world context." – by Chelsea Frajerman Pardes

Disclosures: Schnipper reported receiving grant funding from Sanofi Aventis for an investigator-initiated study to design and evaluate an intensive discharge and follow-up intervention in patients with diabetes. No other authors reported any relevant financial disclosures.