Imperative Conversations: Managing Transitions of Care in the Hospital

Susan Shepard, MSN, RN, Director, Patient Safety Education.

As the first medical professional liability insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.

Transitions in hospital care can occur many times in the course of a patient’s treatment. Good communication between providers during patient transitions is essential. Communication breakdowns—compounded by human factors such as fatigue, distractions, and reliance on memory—are common threads noted in healthcare provider claims. Standardizing the handoff process has been shown to lower rates of perceived near-miss events and adverse outcomes.

Managing Daily Shift Change

Human errors during care transitions are multiplied when workload, hour restrictions, or other factors increase the number of handoffs.

  • Employ technology whenever possible. The Society of Hospital Medicine introduced the concept of the structured electronic tool for change-of-shift sign-out from one hospitalist to the next.1
  • Implement a structured sign-out protocol. Communicating required information in a consistent way will help decrease human error.
  • Face-to-face handoffs provide an opportunity to ask questions and clarify care needs.
  • Handle sign-outs with care: Actively listen and take notes. If possible, find a quiet area for the handoff.
  • Communicate any anticipated patient care problems, including pending significant laboratory results, procedures, or consultations.

Managing Coverage Change

Patients want and need to understand who is taking care of them. In restaurants, servers are typically trained in how to make the transition: The current server introduces the new server personally, and lets the patron know that the new server is now attending the table. This same technique works well with patients. A hospitalized patient can be overwhelmed when a new caregiver comes into the room. Without proper introductions and good handoffs, the patient can easily become confused—which puts you at risk.

  • When changing coverage, let your patient know who will be taking over for you. Consider handing the patient your colleague’s business card so the patient is left with information on the next care provider and how to contact him or her.
  • Use a “transitions” checklist to ensure that all information is included and you rely less on your memory.
  • Ask your patient to specify the issues he or she wants communicated to the subsequent treating hospitalist.
  • Discuss with the patient and family how the pending tests, consults, and the treatment plan will be dealt with going forward.
  • Document a recap of the care provided and outline any follow-up issues.

Understanding where and how gaps occur in your handoff communications is essential due to today’s fragmentation of care. Any care provider that passes off the patient to another plays a key role in improving this aspect of patient safety.


  1.  Beresford L. Change you should believe in: care transitions challenge hospitalists to improve systems, communications. The Hospitalist. 2010;14(7):1. Accessed December 8, 2011.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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