We may not typically think of communication as a clinical skill, but health care providers and patients are frequently exposed to the tragic consequences of inadequate communication of critical information, often at handoffs. In fact, an early 2022 Journal of Patient Safety study titled, “Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims” found that approximately 40% of MPL cases in the Candello database that involved communication failures included a handoff of care – 77% of which were likely preventable with a handoff tool. Cases involving communication errors were also found to be more expensive to defend: the 498 communication claims in this study accounted for $58.0 million in payments, versus $39.1 million for cases that did not involve communication errors.
The findings of the study are the foundation of this presentation including details of the data analysis, and the importance of implementing handoff communication tools and strategies which have been shown to mitigate the risk of patient injury and the likelihood of medical malpractice claims.
In addition, Dr. Chris Landrigan, Chief of General Pediatrics at Boston Children’s Hospital, Director of the Sleep and Patient Safety Program at Brigham and Women’s Hospital and Co-Founder of the I-PASS Patient Safety Institute, shared his reflections on why patient handoffs are a hot spot for poor communication, and why healthcare organizations should strongly consider implementing a structured written and verbal handoff system to ensure that information isn’t missed during transitions of care.
Christopher P. Landrigan, MD, MPH is the Chief of General Pediatrics at Boston Children’s Hospital, Director of the Sleep and Patient Safety Program at Brigham and Women’s Hospital, and the William Berenberg Professor of Pediatrics at Harvard Medical School. Dr. Landrigan was a founding member of the Harvard Work Hours, Health, and Safety Group, the founding chair of the Pediatric Research in Inpatient Settings (PRIS) Network, a founder and Principal Investigator of the I-PASS Study Group, and a founder of the I-PASS Patient Safety Institute.