Care Coordination and Handoffs

The coordination of care involves a number of transitions, or handoffs, from one team member to another. Smooth transitions and accurate communication among team members are important aspects of daily patient care.

Handoffs can sometimes be stressful and confusing for patient and families. It is helpful to understand what information nurses and others share. Some hospitals have specific handoff procedures to reduce the chance for error and improve the patient experience.

Care Team Handoffs

Transitions of care, or handoffs, typically happen when:

• One nursing shift ends and another shift begins
• The patient is transferred between internal departments
• The patient is discharged to an outside facility
• One physician or specialist hands off to another care provider

During transitions, important information is shared. This guarantees that the incoming care team member has the latest information.

Information shared during handoffs includes:

• Patient’s diagnosis
• Vital signs
• Medications needed (schedule and instructions)
• Schedule of tests and procedures
• Results of tests and procedures
• Plan of care
• Last time the patient ate or drank
• Medication and food allergies
• Identification of legal guardian

Nurses usually ask questions to confirm information multiple times a day. This this can be frustrating for patients and families. However, this reduces the chance for mistakes. Clear, accurate communication among team members helps keep patients safe.

Handoff Protocols

Many hospitals have specific procedures for communication during transitions. These protocols vary from hospital to hospital, but generally include some key elements.

• Patient identification: Verifying name, age and date of birth to ensures that care is given to the correct patient.
• Health situation: Considering diagnosis, treatment plan, and provider’s most recent assessment helps determine the best course of action in the face of a need, concern, or complaint.
• Medical background: Checking vital signs, list of medications, laboratory results, and medical history, ensures that care is consistent with the patient’s medical background and current health needs.
• Safety Concerns: Identifying food and drug allergies, lab reports, social and family factors, or other concerns helps protect patient health and safety.
• Timing: Planning care schedules, such as when medications and treatments are given and in what order, ensures the proper sequence of care is followed.
• Responsibility: Identifying the care team member responsible for specific actions or aspects of care helps coordination of care.

Some situations require team members involved in handoffs to identify themselves to each other, including their roles and jobs.

What Patients and Families Can Do

It can be stressful and confusing to keep track of all the people involved in a child’s care. Caregivers have an added responsibility because children cannot advocate for themselves as adults do.

There are a number of ways patients and families can help in care coordination. Taking an active role can reduce worry, stress and the potential for mistakes.

• Get familiar with hand-off procedures. Review the hospital’s protocol. Ask questions, and know the reasons for specific steps.
• Understand the role of each care team member. Knowing who is responsible for what—and who can answer certain questions—can improve care and reduce the chances for misunderstanding.
• Ask for the care team member name and schedule. This can improve communication and help families know what to expect.
• Remember that care team members are human. When mistakes happen, address the issue with the provider respectfully but directly. If needed, contact a supervisor or patient advocate. A patient advocate is a hospital professional who helps patients navigate care and assists with concerns. Like any relationship, good communication is key.
• Actively participate in handoffs. Some hospitals include patients and families in the process. Families may be able to be present during rounds to take notes, ask questions, clarify the plan for the day, and provide input on how the child is doing. If available, this is a great opportunity to partner with the care team members.
• Write down care information. Patient rooms often have a whiteboard for communication. It can also help to keep a notebook to track medical and care updates.