Preventing Medical Errors During Handoffs

Conclusions: Given the increasing frequency of handoffs in hospitals following resident workhour reductions and the high frequency with which miscommunications lead to serious medical errors, disseminating high-quality handoff improvement programs has the potential for benefit. Improvements in verbal and written handoff processes occurred and resident workflow did not change adversely.

Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, Yoon CS, Lipsitz SR, Wassner AJ, Harper MB, Landrigan CP. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013 Dec 4;310(21):2262-70. doi:10.1001/jama. 2013.281961. PubMed PMID: 24302089.

Note: Co-author Carol Keohane joined CRICO as Assistant Vice President for CRICO’s Academic Medical Center’s Patient Safety Organization subsequent to the completion of this study.