Hospitals like to project an image as high-tech, well-oiled machines that
provide efficient care to every patient, every time. As patients, or potential
patients, we want to believe this impression, but a look behind glossy
hospital advertisements reveals some disturbing problems with how hospitals
provide basic medical care.

Take, for instance, a patient hand-off, also known as a sign out. This
is the process by which an outgoing shift of doctors transfers the care
of hospitalized patients to the incoming shift of doctors. Most often,
these doctors are medical residents, physicians-in-training who have completed
medical school and work long hours in hospitals caring for patients.

Surprisingly, the sign-out process is not discussed much in medical school
or residency. “Patient handoffs are a non-standardized process and
a skill that’s not even taught,” pediatrician Ted Sectish
told the New York Times in a recent article on the subject.

Indeed, a 2006 study from the Archives of Internal Medicine found that
60 percent of medical residency programs did not provide any lectures
or workshops on sign-out skills. Worse yet, the study found that 55 percent
of programs did not consistently require both a written and an oral sign-out
at transfers of care, 34 percent left sign-outs to residents alone, without
the participation of the supervising doctor, and 59 percent of programs
had no means of informing nurses that a transfer had taken place.

What does this mean for patient safety? A lot. If the doctor ending his
shift does not accurately and thoroughly convey a patient’s condition
to the doctor beginning his shift, the patient’s safety and well-being
is unnecessarily put at risk. Even something as simple as a test or X-ray
result can be lost in the transition, leading to catastrophic consequences
for the patient.

“Residency programs need to recognize the problem and address it
in some way,” Dr. Leora Horwitz
told medical journal
The Hospitalist.

Medical schools and residency programs need to teach best practices for
transferring patient care between shifts at a hospital. The process needs
to be standardized both throughout a hospital and throughout the country.
Also, supervising staff physicians need to provide better hands-on training
and model good patient hand-off practices.

Studies have proven that hospitals can keep patients safer, reduce medical
errors, and improve patient care when they take steps to assure a smooth
and thorough patient hand-off. One
study, published in the journal
Teaching and Learning in Medicine, found the use of standardized written sign-out sheets significantly improved
the completeness and effectiveness of hand-offs between night and day
medical residents.