An 82-year-old woman is hospitalized in a busy tertiary care hospital due to fever and shortness of breath. The patient has a history of chronic obstructive pulmonary disease. She is diagnosed with pneumonia and started on empiric antibiotic therapy overnight by the admitting physician. After several days of treatment, the patient's condition deteriorates, and she is transferred to the intensive care unit. Sputum cultures were obtained on admission, but the results were not checked by the daytime team, resulting in a delay in initiating more specific antibiotic treatment. Which of the following interventions would be most effective to prevent this type of medical error?

Question

An 82-year-old woman is hospitalized in a busy tertiary care hospital due to fever and shortness of breath.  The patient has a history of chronic obstructive pulmonary disease.  She is diagnosed with pneumonia and started on empiric antibiotic therapy overnight by the admitting physician.  After several days of treatment, the patient's condition deteriorates, and she is transferred to the intensive care unit.  Sputum cultures were obtained on admission, but the results were not checked by the daytime team, resulting in a delay in initiating more specific antibiotic treatment.  Which of the following interventions would be most effective to prevent this type of medical error?

Quizplus · Accepted Answer

In the hospital setting, multiple providers will assume responsibility for a patient's care at different times of the day, which can result in discontinuity of care. As a result, patients are at higher risk of adverse outcomes when providers do not communicate well during transitions. The process of transferring responsibility for medical care is referred to as a patient handoff, with "sign-out" referring to the process of transmitting information about the patient and needed follow-up care. Oversights and communication failures during the sign-out and handoff process have been linked to adverse events in a range of hospital settings. Omission of key information during handoffs can result in medication errors, avoidable escalations in care (eg, transfer to the intensive care unit), redundancies in care, and delays in diagnosis or treatment. Standardized handoffs that include specified key elements (eg, a systematic procedure for sign-out, checklists of tasks that need to be completed) have been shown to significantly reduce preventable adverse events. (Choices A and B) Reducing patient caseloads and increasing the frequency of team meetings to discuss critically ill patients can both provide more time for physicians to communicate patient care information. However, these interventions would not ensure that critical information is transmitted consistently between providers. (Choice C) Consulting an infectious disease specialist would help ensure correct antibiotic treatment and could be appropriate in this patient depending on the clinical scenario and/or culture results. However, this intervention is not cost-effective for every patient and therefore would not be the most effective intervention. (Choice D) Requiring more detailed sign-out notes provides more information on each patient but decreases efficiency and increases the probability that important details will be overlooked. Applying a systematic organization method to sign-out notes is a more effective strategy to ensure that essential tasks are not neglected. Educational objective: Communication failures between physicians during patient handoffs are a major cause of medical errors and can be reduced by use of a standardized handoff process including systematic sign-out notes. __________ References: Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. (http://www.ncbi.nlm.nih.gov/pubmed/24302089) Changes in medical errors after implementation of a handoff program. (http://www.ncbi.nlm.nih.gov/pubmed/25372088)

An 82-Year-Old Woman Is Hospitalized in a Busy Tertiary Care