is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society.
TS-Si supports open
and immediate access to
publicly funded research
| Restricting Physician Work Hours Fumbles Patient Hand-offs |
 |
 |
| SciMed - Healthcare | |||
| TS-Si News Service | |||
| Monday, 15 March 2010 10:00 | |||
|
Chicago, IL, USA. Outgoing hospital physicians hand off important information to their replacements in a brief shift change meeting. A new study of this process says the most important information is not fully conveyed in a majority of cases, even as physicians rate their communication as successful. The research, by University of Chicago researchers in the journal Pediatrics, highlights the importance of educating doctors about successful communication skills during hand-offs. The results also emphasize the risk inherent in increased hand-offs necessitated by restrictions on medical resident work hours, even as further work limits are being discussed. "When resident hours are shortened, you have more hand-offs," said Vineet Arora, MD, assistant professor of medicine at the University of Chicago Medical Center. "You could have concerns about either a tired physician who knows the patient or a well-rested physician that may not know the patient. The tradeoff is between fatigue and familiarity."
Chevy Chase, MD, USA. The Endocrine Society has released a new clinical practice guideline on the diagnosis and treatment of  congenital adrenal hyperplasia (CAH). The guideline features a series of evidence-based clinical rec...Baltimore, MD, USA. Scientists have produced the very first epigenetic landscape map for tissue differentiation, based on the occurrence of a common chemical change called methylation, often is associated with turning off gen..."Reducing hours is good, but there's a cost that is not obvious at all, and this study really spells that cost out. But despite these miscommunications, interns on both sides of the hand-off consistently rated the quality of their communication as very high. Boaz Keysar, PhD, a professor of psychology at the University of Chicago and co- author of the paper, said that this disconnect between perceived and actual success of communication is common in other settings. "You would imagine the kind of miscommunication we discover elsewhere actually might be reduced when the stakes are high in a clinical setting, because it matters so much," Keysar said. "But the opposite is true, which I think is counter-intuitive and important to know." The results were even more striking given the optimal hand-off conditions for interns at Comer Children's Hospital. In each hand-off, a conversation takes place in a designated room under supervision by more experienced physicians. In previous research, Arora found that many hospitals and programs have much less organized hand-off procedures — if they occur at all. In illustrating the communication breakdowns that plague even best-case hand-off conditions, Arora and Keysar hope to inform medical centers and schools of the need for better education about hand-offs. The study found that "anticipatory guidance" — offering to-do items or if-then advice — was a more effective way of communicating information between interns than passing on knowledge items in bulk. Currently, Arora and colleagues are working on a simulation exercise for fourth-year medical students to train more effective hand-off communication skills. Such training, they hope, will be more effective than relying upon computer programs and electronic medical records to facilitate hand-off communication. A verbal exchange of information remains important so that young doctors can make quick, informed decisions about patients, Arora said. "IT solutions cannot substitute for a successful communication act," Arora said. "We aren't at the point where computers are going to do that for us. Technology solutions can help so that you have the information that you need when you need it, but to look at that information and be able to make a judgment about what to do, that is what the hand-off conversation is for." But while researchers look for the best way to improve those conversations, Arora and Keysar hope that medical policymakers are aware of the risks inherent in the current hand-off model. As the Accreditation Council for General Medical Education ponders further restrictions upon the number of hours residents and interns can work, the consequences of those reduced hours must be acknowledged, they said. "We tend to be very myopic in the way we think about this problem," Keysar said. "Reducing hours is good, but there's a cost that is not obvious at all, and this study really spells that cost out. It's very difficult for us to gauge how well we are understood, and this should be taken into account in the trade-off between number of work hours and fatigue." ParticipantsVivian Chang, MD, now at the University of California, Los Angeles, Shiri Lev-Ari, MA, of the University of Chicago Department of Psychology and Michael D'Arcy, BA, now at the University of California, Berkeley.
CitationInterns Overestimate the Effectiveness of Their Hand-off Communication. Vivian Y. Chang, Vineet M. Arora, Shiri Lev-Ari, Michael D'Arcy, and Boaz Keysar. Pediatrics 2010; 125(3): 491-496. doi:10.1542/peds.2009-0351
Abstract Objective. Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. Methods. Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. Results. We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. Conclusions. Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality. Keywords: work hours, hand-off communication, patient safety.
We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission. To create link towards this article on your website, copy and paste the text below in your page. Preview : 
Bookmark
Email This
Comments (2)
 Write comment
|
|||
| Last Updated on Sunday, 14 March 2010 00:11 |
The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. The sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates.
Subscribe to this comment's feed
Show/Hide comments
Show/Hide comment form
The TS-Si News Service
and the TS-Si Research Service
are collaborations of TS-Si officials, staff, contributors, and corresponding institutions. Contents do not necessarily convey official positions of
TS-Si, its partners, or its affiliates. 