Utilizing information technology to mitigate the handoff risks caused by resident work hour restrictions.
Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called "handoff") at the end of shifts. WHERE ARE WE NOW?: A greater frequency of handoff leads to an increased risk of physician error. Information technology can be used to minimize that risk. WHERE DO WE NEED TO GO?: A computer-based expert system can alleviate the problems of data omissions and data overload and minimize asynchrony and asymmetry. A smart system can further prompt departing physicians for information that improves their understanding of the patient's condition. Likewise, such a system can take full advantage of multimedia; generate a study record for self-improvement; and strengthen the interaction between specialists jointly managing patients. HOW DO WE GET THERE?: There are impediments to implementation, notably requirements of the Health Insurance Portability and Accountability Act; medical-legal ramifications, and computer programming costs. Nonetheless, the use of smart systems, not to supplant physicians' rational facilities but to supplement them, promises to mitigate the risks of frequent patient handoff and advance patient care. Thus, a concerted effort to promote such smart systems on the part of the Accreditation Council for Graduate Medical Education (the source of the duty hour restrictions) and the Association of American Medical Colleges (representing medical schools and teaching hospitals) may be effective. We propose that these organizations host a contest for the best smart handoff systems and vigorously promote the winners.
Bernstein
Joseph
J
Department of Orthopaedic Surgery, Veterans Hospital, Philadelphia, USA. orthodoc@uphs.upenn.edu
MacCourt
Duncan C
DC
Jacob
Dan M
DM
Mehta
Samir
S
D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D005103:Expert Systems; D006751:Hospital Information Systems; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D019300:Medical Errors / Q000517:prevention & control*; D008490:Medical Informatics; D016347:Medical Records Systems, Computerized; D010348:Patient Care Team; D010561:Personnel Staffing and Scheduling; D018570:Risk Assessment; D017751:Safety Management; D013997:Time Factors; D016526:Workload
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