Communication Breakdowns During Patient Handoffs

Good medical care is dependent upon effective communication and safety checklists.  Incomplete patient information, missing tests, and ineffective communication are causing a rise in medical errors and liability claims.  As the number of providers in a health care team grows, so does the number of miscommunication errors.  It is rare for patients to be treated by only one physician during an entire course of treatment anymore.  COPIC, a professional liability insurance company based in Denver, has seen rising claims from a variety of patient handoffs in recent years.  Patient handoffs include transfers from partner to partner, primary care physician to specialist (and the reverse), institution to institution, or during shift changes.  The practice of medicine has become a team effort, with many people having to work together.  According to Lytton Smith, MD, a California family physician, “Physicians must embrace this team concept to achieve the best medical outcomes.  The closer practitioners work together, the better."

Ineffective communication can lead to improper diagnosis and delayed or improper medical treatment.  Dr. Alan Lembitz, vice president of COPIC, points out one family’s story of communication breakdowns that resulted in a tragic death.  A neonatologist treated a newborn child within 12 hours after birth.  The neonatologist ordered a bilirubin test.  However, another neonatologist, who was unaware of the lab results, discharged the child within 24 hours.  At 60 hours, the baby visited a pediatrician and a bilirubin test was again ordered before the pediatrician left for vacation.  The covering pediatrician was not informed of the baby’s history, and the bilirubin test was never done.  At 125 hours, the baby was admitted to the hospital and died of kernicterus, a form of brain damage caused by excessive jaundice and high bilirubin levels.  The baby died from a preventable disease because of a breakdown in communication between treaters. 

According to Dr. Lembitz, avoiding communication breakdowns starts with two forms of successful information delivery: synchronous and asynchronous.  In synchronous communication, physicians should talk face-to-face and avoid interruptions as much as possible.  The receiver of the information should be focused on listening instead of talking.  In asynchronous communication, physicians need to first decide what is the best method of delivery and be consistent about the type of information being delivered.  It is critical that the receiver confirms that the information was received. Lastly, it is essential that physicians review a safety checklist that includes items such as whether discharge summaries have been completed and if follow-up appointments or tests have been scheduled.  Other items might include, whether a patient received clear instructions on follow-up care and whether contact was made with a patient’s primary care doctor or referring doctor. 

It is important that you take an active role in your care.  You should develop your own checklist to use when visiting your doctor.  Your checklist should include questions, such as:  

• Do I fully understand my diagnosis?
• Do I need a follow-up appointment?  If so, when should it be scheduled?
• What are the names of my medications?  Do I have a clear understanding of dosage, drug interactions, and side effects for each medication?
• Who do I contact if I have questions or problems?
• Do all my doctors have all my medical information?

Having answers to these questions when seeing multiple caregivers can help to avoid communication errors, which means safer medical care for you and your family.