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Web Tool Reduced Medical Missteps During Hospital-Shift Changes: Study

By Kaiser Health News  
   August 02, 2016

Researchers analyzed the effect of a web-based tool that uses patient medical records to enhance communication during the patient handoff. The number of medical mistakes was cut in half the year after the hospital introduced the software tool and taught employees how to use it.

This article first appeared August 1, 2016 on the Kaiser Health News website

By Shefali Luthra

It's 4 p.m., and if you're a hospital patient, that could be one of the most critical times of the day. Your doctor's shift just ended, and someone new will take over your care. How these professionals communicate could have major repercussions for your recovery.

Those shift changes, also known as handoffs, are prime opportunities for key information about a patient's condition to get lost in the shuffle. It's essential that these relevant points are not only captured, but also effectively conveyed between hospital staff.

All too often, that doesn't happen. But a research letter published Monday in JAMA Internal Medicine suggests hospitals can avoid such missteps by using technology to improve communication among the doctors, nurses and other health care providers at that vital point in care.

"This shows that [an electronic patient record] can help mitigate medical error," said Dr. Stephanie Mueller, the study's main author and an associate physician in primary care and general internal medicine at Brigham and Women's Hospital.

Researchers analyzed the effect of a web-based tool that uses patient medical records to enhance communication during the patient handoff. It scans a patient's electronic medical record for the information that doctors and other health workers need to know most. Then it automatically pulls that information into a separate page that's been designed to highlight those essential details.

To evaluate the tool, the researchers surveyed residents at the end of their shifts who worked "nightfloat" — midnight to 7 a.m. — and "twilight" — 4 p.m. to 12 a.m. They checked for possible medical errors, and then rated those errors in terms of how avoidable they were. The survey started in November 2012 in advance of the tool's February 2013 introduction, and then compared the level of error that took place before the tool was being used with those that occurred in the year that followed. Overall, the survey examined more than 5,000 patient cases.

The result: The number of medical mistakes was cut in half the year after the hospital introduced the software tool and taught employees how to use it. There were 77 errors identified between November 2012 and February 2013, compared with 45 in the following year.

As hospitals become more shift-driven because of increased attention to regulating physician work hours, these figures take on added importance. In the past, residents often worked 24-hour shifts. But safety advocates worried such a system could mean sleep-deprived doctors, who in turn would make more errors while treating patients. In fact, reducing hours has increased the number of patient handoffs, meaning there are more opportunities for information to get lost and for mistakes to be made.

The researchers argued their findings offer a path forward.

Brigham and Women's built its tool in-house and has integrated it into the hospital's commercially produced electronic health record.

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Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


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