Reducing Risks Associated With Patient Handoffs

Patient handoffs are a common but risky activity in chiropractic care. Handoffs occur during patient transfers within the practice, referrals to specialists, and referrals to other chiropractic practices.

With every patient handoff, a potential risk exists for transfer of inaccurate or inadequate information, which can result in patient harm. Important treatment details can be forgotten or miscommunicated for various reasons, including “training and expectations, language barriers, cultural or ethnic considerations, and inadequate, incomplete, or nonexistent documentation . . .”1

Because communication breakdowns are a leading cause of healthcare errors, it is imperative for chiropractic practices to devise effective strategies for communicating when transitioning the responsibility for patient care and transferring patient information. This checklist is designed to help chiropractors and staff evaluate organizational handoff protocols and identify potential safety gaps.

YesNo
Has your practice evaluated situations in which transfers of care commonly occur in the course of patient care and identified potential communication barriers or issues that might impede care transitions? Has this information been used to develop a written policy about handoffs?
Does your practice’s handoff policy define the process for patient handoffs, including the specific roles of the sender and receiver as well as the expectations for verbal and written communication?
Does the handoff policy specify the minimum requirements for what types of information need to be provided during a handoff (e.g., patient diagnosis, pertinent demographic information, test/lab results, medical history and physical exam results, current stage of treatment, any recent changes in condition, potential complications that might occur, active problem list, medications and allergies, ongoing or anticipated therapy, etc.)?
Are standardized checklists and communication techniques (e.g., Situation-Background-Assessment-Recommendation [SBAR], IPASS, and I PASS THE BATON) used as part of handoff protocols? 
Does your practice’s handoff process include interactive communications (i.e., include an opportunity for questions and answers), limited interruptions, a process for verification, and an opportunity to review relevant historical data?
Do chiropractors and staff members receive training on handoff policies and protocols? Are they given the opportunity to clarify information and ask questions?
Are staff members encouraged to report problems and barriers associated with handoff protocols?
Does your practice audit handoff processes to ensure that providers and staff members are using appropriate forms, tools, and checklists?
Has your practice established a detailed process for exchanging patient information during patient transfers within the practice, patient transfers to other chiropractic practices, patient transfers to other providers (e.g., specialists), and on-call coverage situations? Does your practice use standardized templates to support this process?
Is a process in place for retrieving and following up on messages from your practice’s answering service? Does this process occur on a daily basis?
Do practice policies designate responsibility for review, follow-up, and documentation of diagnostic test results, lab orders, and consultative reports?
Do the practice’s manual and electronic communication systems facilitate the handoff process and support communication efforts?

To learn more information and identify best practices for patient handoffs, see MedPro’s Risk Resources: Handoffs and Care Transitions.

Endnotes

1 The Joint Commission. (2017, September). Sentinel Event Alert 58: Inadequate hand-off communication. Retrieved from www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-58-inadequate-hand-off-communication/


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