Miscommunication, Handoffs, and Patient Presentations Flashcards
What are the two most important, preventable etiologies of medical errors in the hospital setting?
- Miscommunication
- Handoffs errors
What method can be used to reduce miscommunication errors in the hospital setting?
Closed-loop communication
How does closed-loop communication work (3 steps)?
- Information is given →
- The receiver repeats back the information →
- The giver confirms the accuracy
When performing a handoff of patient care, what are some aspects of the setting and/or format that are more conducive to a successful, safe handoff?
- Interactive communications
- Limited interruptions
- A process for verification
- An opportunity to review any relevant historical data
What aspects of the environment will increase the likelihood of success in patient handoffs?
- Private, quiet area
- Limited distractions
- Organizational safety
What language should be used and/or avoided in performing patient handoffs?
Use: standardized medical terminology
Avoid: colloquialisms; abbreviations (unless universally well-known)
When giving a nurse or provider or physician instruction, how can one help prevent miscommunication in a quick, simple manner?
Use closed-loop communication
(E.g., just to make sure I stated the order clearly, would you mind repeating it back to me?)
What mnemonic can be used to remember the format for handoffs in acute settings requiring quick communication?
SBAR
Situation-Background-Assessment-Recommendation
Describe the information quickly transmitted in a handoff using the SBAR mnemonic:
Situation -
Background -
Assessment -
Recommendation -
Describe the information quickly transmitted in a handoff using the SBAR mnemonic:
Situation - the immediate concern and/or reason for hospitalization (“COPD exacerbation;” “foreign body inhalation;” etc.)
Background - history of illness; disease/treatment course; etc.
Assessment - immediate needs; options and expected outcomes
Recommendation - next steps
What mnemonic can be used to remember the format for handoffs in calm, non-acute settings; e.g., the day team handing off to the night team?
I-PASS
Illness Severity
Patient Summary
Action List
Situation Awareness and Contingency Planning
Synthesis by receiver
What are the components of the ‘I-PASS’ handoff format?
Illness Severity
Patient Summary
Action List
Situation Awareness and Contingency Planning
Synthesis by receiver
When using the ‘I-PASS’ handoff format, what are three main options for communicating illness severity?
“Stable,” “watcher,” or “unstable”
When using the ‘I-PASS’ handoff format, what should be included in a patient summary (long-ish section)?
- Summary statement
- Events leading to admission
- Hospital course
- Ongoing assessment
- Plan
When using the ‘I-PASS’ handoff format, what is included in the action list?
- Any to-do items
- Timeline and ownership
When using the ‘I-PASS’ handoff format, what should be communicated in the situation awareness section?
- Knowledge about what’s going on
- A plan for what might happen
When using the ‘I-PASS’ handoff format, what is included in the synthesis portion?
The receiver summarizes, asks questions, and restates key action items
When utilizing a SOAP note to present a patient to an attending, what is the purpose of each section of the presentation?
Subjective: communicates patient’s presentation and relevant history
Objective: communicates patient’s relevant vitals, physical examination, and imaging/laboratory data
Assessment: communicates any diagnosis hypotheses and the expected clinical trajectory
Plan: communicates the hypothesis testing that will take place
When presenting a patient, why should I not say, “the examination is normal, except for…”
After hearing the word ‘normal,’ most attendings shut off their brains.
Just state pertinent findings and move on; don’t editorialize or add superfluous words.
Much of medical school was about learning how to collect patient data and present it in detail.
How should my presentations change during intern year?
Learn to synthesize the collected data into information that can be presented quickly and efficiently as possible.
Learn to cut out all the superfluous items and just present the findings pertinent to the case.
When presenting my plan for a patient, in what order should I proceed?
- Most serious problem
- Next most serious problem
- Etc.
- Barriers to discharge
