Eye Errors Between Shifts
CIR: Must Maintain Continuity of Care

By MEREDITH KOLODNER

Sometimes contract negotiations can lead to more than wage improvements and health-care deductible adjustments.

CIR photo PATIENT SAFETY: The Committee of Interns and Residents joined forces with the Health and Hospitals Corporation to sponsor a day-long conference last week on how to improve communication between medical teams when they hand over patients during shift changes. 'We wanted to make sure everybody who's involved in patient care was at the same place at the same time,' said CIR President Luella Toni Lewis.

The union representing Interns and Residents in the city's hospitals walked away from the last bargaining round with an agreement to sponsor a joint conference on how to ensure patient safety between shift changes.

Key to Averting Errors

Last week's all-day session in mid-town Manhattan, co-sponsored by the Health and Hospitals Corporation and the Committee of Interns and Residents, brought together doctors, nurses, computer experts and administrators to hammer out ways to improve the transfer of information between shift changes of health-care personnel. Studies have found that 70 to 80 percent of medical errors come from miscommunication between staff members.

"We've never done anything like this before," said CIR President Luella Toni Lewis. "We wanted to make sure everybody who's involved in patient care was at the same place at the same time. It's a new thing."

CIR members say that as pressure has increased to reduce the 24- to 30-hour shifts frequently worked by Interns and Residents, objections have been raised that shortening the shifts would lead to an increased number of patient "hand-overs" and damage patient care.

CIR photo REDUCING MEDICAL ERRORS: Dr. Christopher Landrigan (far left), the sleep and patient safety director at Boston's Brigham and Women's Hospital, led a workshop last week at a conference jointly sponsored by the Committee of Interns and Residents and the Health and Hospitals Corporation aimed at making patient transfers between shifts safer. He said that the conference would allow health-care providers to deal collaboratively with 'a problem that's been there for a while.'

"As hospitals in places like New York have tried to reduce the number of hours worked," said Christopher Landrigan, the sleep and patient safety director at Boston's Brigham and Women's Hospital, "the frequency with which they have had to exchange patient information has increased. It has unmasked a problem that's been there for a while."

A 1999 study by the Institute for Medicine found that between 44,000 and 98,000 patients in the U.S. die each year due to medical error.

The conference featured presentations from Drs. Landrigan and Lewis and HHC President Alvin Aviles. It also included case studies from doctors at Bellevue and North Bronx Healthcare Network, which have been recognized as having some of the best practices for patient transfers.

CIR members stressed that reducing work hours need not be counterposed to safe transfers. "Just because there are more hand-overs," said Dr. Lewis, "that doesn't mean they have to be unsafe hand-overs. Fresher minds are better able to process information."

Hand-overs occur when health-care providers end their shifts while a patient is still being cared for and crucial patient information must be absorbed by the new team. Conference organizers were hoping to come out of the sessions with concrete procedures that could be implemented across a hospital, and eventually throughout the entire HHC system.

More-Orderly Transfers

Some of the proposals included having a uniform way of recording the information, whether electronic or on a standardized paper form. Doctors also said that having a centralized protected location and time to transfer the information made for more effective communication. For example, instead of caregivers meeting in the hallway "at the end of the shift," they would choose an exact time, in a particular conference room, to allow all members of the medical team to take part without distractions.

"One of the most innovative things about this conference," said Dr. Landrigan, "is that it is usually an individual residency working on [a solution] in isolation from administrators, or it comes down from on top without any communication with the front lines."

CIR members said they appreciated the opportunity to openly and honestly discuss the problems and find answers that would benefit both staff members and patients.

Referring to the Super Bowl champions, Dr. Lewis said, "If you think about the Giants and teamwork, it's really basic. We want to figure out what we can do tomorrow and down the road reconvene and move the process forward even more."