August 18, 2006

Passing the baton SEAMlessly: Improving patient hand-offs

As the MGH continues to prepare for the upcoming, unannounced Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) survey, employees and staff members throughout the hospital remain committed to improving patient safety and continually providing the highest standards of care. Recently, a special area of focus has been improving communications surrounding "hand-offs," when a patient's care is transferred from one health care provider to another. Hand-offs are one aspect of the National Patient Safety Goals (NPSGs), which were established by JCAHO to bring attention to patient safety issues and to help health care organizations develop systems and techniques to further improve patient safety. Specifically, hand-offs fall under NPSG #2, "Improving Communication Among Caregivers."

The purpose of a hand-off is to provide accurate and thorough information about a patient's care, treatment, services, current condition and any recent or anticipated changes in his or her condition. Patient hand-offs can occur at various times including nursing shift changes, physicians transferring complete care of a patient to another, physicians transferring on-call responsibility, temporary transfers of responsibility among caregivers, laboratory and radiology results being sent to a doctor's office, patients being moved from the Emergency Department to inpatient units, and patients being transferred from the MGH to other hospitals, nursing homes and home health care locations.

Patient hand-offs are a particularly vulnerable time for communication failures among caregivers, and an improperly performed hand-off can have serious safety
consequences. To ensure effective hand-off communications, it is recommended that MGHers follow the SEAM approach when transferring the care of a patient:

S Summary and Status
EA Every Active Issue
M Management of Each Issue

This standardized approach makes hand-offs a shared responsibility among all caregivers and helps to make sure that all aspects of a patient's care are addressed. A successful hand-off also should include ample time to ask and respond to any questions health care providers involved may have.

The MGH's compliance on hand-offs will be reviewed during patient tracers. During tracers, JCAHO surveyors will select patients who have gone through a number of the hospital's services and "trace" compliance with JCAHO standards at each stop along the patient's journey through the health care system. "Although hand-offs always have been an important part of patient care, they also have been a time of vulnerability," says Maryanne Spicer, director of MGH Compliance. "We hope this important hand-offs safety initiative championed by JCAHO will be another important advance in care for our patients."

To learn more about how to prepare for the upcoming JCAHO survey, visit
www.massgeneral.org/jcaho.