A 59-year-old obese woman with a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease (COPD) is admitted with COPD exacerbation. Management is complicated by difficulty controlling the patient's blood glucose, with levels of 100-300 mg/dL throughout the day. On her second hospital day, a 7 x 3 cm abscess of her left buttock is found and requires incision and drainage. Following the procedure, the surgeon instructs the overnight hospitalist to obtain serial ultrasound examinations to monitor the abscess. During the course of signing out, the hospitalist expresses concern about the patient's fluctuating blood sugars, provides details on the status of her COPD, and mentions the drainage of the abscess but forgets to mention the need for follow-up ultrasound examination. Due to this oversight, the abscess is not reexamined for several days and worsens significantly, requiring more extensive surgical intervention. Following a review of the adverse outcome, the hospital administration forms a committee to improve patient handoffs between medical staff members. Which of the following interventions would most significantly improve the quality of patient handoffs?

Question

A 59-year-old obese woman with a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease (COPD) is admitted with COPD exacerbation.  Management is complicated by difficulty controlling the patient's blood glucose, with levels of 100-300 mg/dL throughout the day.  On her second hospital day, a 7 x 3 cm abscess of her left buttock is found and requires incision and drainage.  Following the procedure, the surgeon instructs the overnight hospitalist to obtain serial ultrasound examinations to monitor the abscess.  During the course of signing out, the hospitalist expresses concern about the patient's fluctuating blood sugars, provides details on the status of her COPD, and mentions the drainage of the abscess but forgets to mention the need for follow-up ultrasound examination.  Due to this oversight, the abscess is not reexamined for several days and worsens significantly, requiring more extensive surgical intervention.  Following a review of the adverse outcome, the hospital administration forms a committee to improve patient handoffs between medical staff members.  Which of the following interventions would most significantly improve the quality of patient handoffs?

Quizplus · Accepted Answer

Explanation: Ineffective patient handoffs can cause significant delays in care, workflow redundancies, and adverse patient outcomes due to errors or oversight. Handoffs frequently occur in less-than-ideal environments, with time constraints and interruptions from staff members. However, most errors result from a failure to communicate in a systematic manner that incorporates the "big picture" and assists with anticipatory decision-making. Using an organized template or a checklist has been shown to improve sign-out efficacy and accuracy. Sign-outs should be conducted verbally, face-to-face, with an updated, succinct written component. Essential components of an effective sign-out are shown in the table. 11ec2b69_c0d7_a08c_8f63_b5ea3f08994b_MD0005_00 (Choice A) A quiet workplace in which physicians can communicate patient information is ideal but has not been shown to improve outcomes as effectively as systematic checklists and templates. (Choice B) Extensive and detailed notes on each patient can be challenging for a new physician, who often requires direct and concise data to act quickly in time-sensitive situations. When information is unorganized and non-systematic, it is frequently overlooked or misinterpreted. (Choice C) Although it is important for physicians to designate an appropriate amount of time for patient sign-outs, additional time does not necessarily lead to improved quality of sign-outs or better outcomes. (Choice D) Although a bedside sign-out can help acquaint the new physician with the patients and may allow for a better focus on patient care, it has not been shown consistently to improve the quality of handoffs and requires greater amounts of limited physician time. Educational objective: Undesired medical outcomes (eg, errors, inefficiencies, delays) often result from inadequate patient handoffs between medical providers. Use of sign-out procedures that incorporate systematic checklists and templates can reduce the incidence of poor outcomes. References: Development and implementation of an oral sign-out skills curriculum. (http://www.ncbi.nlm.nih.gov/pubmed/17674110) Implementation of an emergency department sign-out checklist improves transfer of information at shift change. (http://www.ncbi.nlm.nih.gov/pubmed/25130675)

A 59-Year-Old Obese Woman with a History of Type 2