Jan 12, 2016
Summary by: Pat Croskerry
It is now well recognized that transferring the care of a patient from one caregiver to another is a vulnerable point in a patient’s care and a potential threat to patient safety. There may be many intra-disciplinary and inter-disciplinary transition points in the ED during an individual patient’s care. The process requires that each participant communicates well with others to establish an accurate shared mental representation of the important issues.
To minimize transition failures, the process should be trained and standardized, recognized as a multi-professional activity, defined by who should be present, where and when it should occur, and have an end-point that is a clear plan for the ongoing care of the patient. The reliability, consistency, and efficacy of the transition should be a hallmark of departmental culture.
Training should be provided in how the process works and how it
fails. The broad distinction between the transfer of poor
information (unwarranted opinions, stereotyping, stigmatization,
gratuitous comments, overconfidence, and other cognitive biases)
and poor transfer of information (unstructured, casual setting,
rushed/fatigued, interruptions/distractions, limited input from
others, verbal only, degraded narrative skills) should be
recognized. It is important to reliably express the amount of
certainty attached to what is actually known at transfer so that
recipients clearly understand what is expected of them.
The vulnerability of human memory should be recognized and
strategies used to deal with it (SBAR, I-PASS and others). There
should be awareness of particular biases in communication at
transition time. Serial position effects describe how primacy
(information presented at the beginning) and recency (the last
information to be presented) may influence what is perceived and
retained. It is important to be aware of specific biases that
operate at transition time: framing, fundamental attribution error,
search satisficing and others) and consider strategies to mitigate
them.