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Transitions in care

 

MRTs relay patient information in a manner that ensures a clear and full understanding between healthcare service providers during transitions in care

 

+ Importance of effective transitions in care

  • Transitions in care involve the transfer of professional responsibility and accountability for some or all aspects of care for a patient or group of patients to another healthcare professional on a temporary or permanent basis.1
    • Transitions can take place within or between departments

  • A transition in care is a vulnerable point on their journey through the healthcare system.
    • It is the point at which the majority (70%) of errors in healthcare occur2 
    • Poor or incomplete communication of information can delay care, cause confusion or, occasionally, lead to disastrous consequences3,4

  • MRTs are aware of facility policies on transitions in care and ensure compliance.

+ Communication

  • The goal of communication during a transition is to provide timely, accurate information about a patient’s care plan, treatment, current condition and any recent or anticipated changes.5
    • The information shared between providers helps update patient care, identifies safety concerns and facilitates continuity of care2

  • There is a need for efficient, reliable information shared in both directions. 
  • Effective communication includes transfer of information within the organization, between staff and service providers, with the patient and family, and to other services outside the organization, such as primary care providers.6

What to communicate

  • MRTs ensure important information is addressed during transitions in care – including (but not limited to):
    • Patient identifiers 
    • An explanation of the planned procedure/treatment 
    • Current patient status  
    • Relevant health record accompanying patient (e.g., has patient/family requested “do not resuscitate” status)
    • Patient isolation status 
    • Information about procedures performed
    • How patient managed procedure/treatment
    • Any problems/concerns while patient was in MRT’s care
    • Issues other healthcare professionals should be aware of post procedure/treatment
    • Serious or unexpected findings (please also see Communication of serious or unexpected findings guideline)
    • Patient risk factors (if any)
  • The information transferred depends on the clinical circumstances and the nature of the interaction with the patient.7 
  • The transition process should include opportunities to discuss the meaning of the information, seek clarification and ask questions.

How to communicate

  • Information about the patient is relayed in a manner that ensures a clear and full understanding between healthcare professionals in the handover:7,8
    • An appropriate amount of time is allowed 
    • Interruptions and distractions are limited
    • The talk back rule is employed to ensure that the information has been understood

Patient/Family involvement

  • If appropriate, the patient or family may take part in the exchange of information during a transition (please also see Patient and family-centred care in practice guideline)
    • This forms part of patient centered care
    • Patient/family may be able to provide essential information during transfer of care

+ Standardized tools for transitions in care

  • Mechanisms and tools to review key patient safety issues, identify errors and limit patient harm (e.g., safety checklist) are helpful in providing a consistent structure to the information exchanged at transition.
    • Written tools help to minimize the reliance on memory

  • Examples of mechanisms to ensure accurate transfer of information may include:
    • Forms and checklists6 
    • Communication algorithms such as mnemonics (e.g., SBAR, ANTICipate, SIGNOUT, DRAW, IPASS the BATON)7 
    • Five Ps (Patient, Plan, Purpose, Problems, Precautions)5
    • Multidisciplinary notes
    • Verbal reports 
    • Patient whiteboards 
    • Electronic tools

+ References

  1. British Medical Association Junior Doctors Committee. Safe handover, safe patients: Guidance on clinical handover for clinicians and managers. 2004. 
  2. Alvarado K, Lee R, Christoffersen E, et al. Transfer of Accountability:Transforming Shift Handoverto Enhance Patient Safety. Healthcare Quarterly 2006;9(Special Issue):75-79. 
  3. Royal College of Obstetricians and Gynaecologists. Good Practice No. 12. Improving Patient Handover. December 2010. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/goodpractice12patienthandover.pdf. Accessed November 3, 2014. 
  4. Hannaford N, Mandel C, Crock C, et al. Learning from incident reports in the Australian medical imaging setting: handover and communication errors. Br J Radiol 2013;86:20120336.
  5. American Medical Association. Patient Handoffs. Resources for Improving Patient Handoffs. Available at: http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/resident-fellow-section/rfs-resources/patient-handoffs.page. Accessed November 3, 2014. 
  6. Accreditation Canada. Required Organizational Practices 2014. Information Transfer.
  7. The Canadian Medical Protective Association. Good Practices Guide. Handovers: Transferring care to others . Available at: http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/communication/Handovers/what_is_a_handover-e.html. Accessed November 3, 2014. 
  8. Canadian Patient Safety Institute. Canadian Framework for Teamwork and Communication. Available at: http://www.patientsafetyinstitute.ca/english/toolsresources/teamworkcommunication/pages/default.aspx. Accessed November 3, 2014.

 

Useful links

 

Validation

July 29, 2014

 

 
Canadian Association of Medical Radiation Technologists
85 Albert St, Suite 1000, Ottawa, ON, K1P 6A4
phone: 613 234-0012 / 800 463-9729
fax: 613 234-1097
www.camrt.ca