Reduce Risks in Patient Handoffs: Signing Off and Signing Out

Ann S. Lofsky, MD, Governor Emeritus, and Susan Shepard, MSN, RN, Senior Director, Patient Safety Staff Education.

Whether signing out to a colleague for the weekend or closing a practice permanently, handing off responsibility for patient care is a complex process that can create liability risks for a physician.

Handoffs

An effective handoff is essential in providing accurate information about a patient’s care, treatment, services, current condition, and any recent or anticipated changes. In our closed claims studies, we find that a lack of communication between care providers often contributes to patient injury.

When a patient handoff between physicians occurs, a best practice is to communicate the following information to the receiving physician: previous treatment, current condition, medications ordered to date, any recent or anticipated changes in the patient’s condition, and actions that still need to be completed.

Although face-to-face communication is the most effective method, telephone communication can also be efficient. Set aside sufficient time to relay the salient information, to ensure the receiver understands the data, and to discuss questions and answers. Standardizing the handoff process and the content will decrease the chances that critical information will be omitted.

Patient Notification

Primary responsibilities for most practice changes focus on good communication with patients. Patients should be told what the changes will be, when they will occur, and how the changes will affect their continued medical care. Keeping your patients informed will prevent claims of abandonment.

If the change in practice entails temporary coverage by another physician, provide the patient with the covering physician’s name, phone number, and the duration of the coverage.

If the change is permanent, a more formal process is necessary. A notice about closing your practice should include at least these elements:

  • The importance of continuing medical care.
  • Information about acquiring a copy of the medical record.
  • The date of final closure.
  • Method(s) for referrals (usually the local medical society).

For more information on closing a practice, see “Notifying The Doctors Company” at the end of this article.

Medical Record Management

A short-term medical care transfer might include a brief oral update to the covering doctor about what to expect with current and acute patients. Make office records available if necessary. Hospital-based patient records should include documentation of the change, usually on the physician order form.

Provide a method for documenting patient phone calls to the covering physician that can be added easily and quickly to the patient’s medical record. Any patient encounter should be documented, as is customary. Unless the matter is emergent, delay releasing medical record information until the temporary coverage ends. Long-term changes require a process that ensures the safety and security of the medical records while providing ready access.

Ensure Continuity of Care

When arranging temporary coverage, select a physician who shares your specialty. If the specialty is surgical or obstetrical, a backup cover may be advisable in the event that your locum tenens is actively involved with another patient. It is also a good idea to select a physician who has privileges at the same hospital.

When selling or closing a practice, similar guidelines apply. If the doctor buying the practice shares your specialty and privileges at the same hospital, it will help ensure your patients’ continuity of care.

Details Matter

If possible, introduce your acute or active patient population to the covering physician. A pre-established process for billing is another important detail. To avoid double billing, determine who will be responsible for billing patients.

Notify other practice associates of your impending absence. Provide your dates of departure and return to applicable office staff, referring practitioners, answering service, local hospital, clinics, nursing homes, etc.

On returning from a temporary change, ask the covering physician to update you. Review documentation in the medical records to address any patient care issues requiring follow-up. Listen to feedback from individuals who worked with the covering physician to learn about the success or failure of the temporary change. Each detail noted above may be applied in reverse when you are the covering physician.

Notify The Doctors Company

Anytime a practice closes permanently, it is necessary to notify your agent or broker and The Doctors Company. This step ensures that past and future claim coverage will be addressed.

A packet of informative materials on closing your practice is available by contacting The Doctors Company at 800.421.2368, extension 1243, or patientsafety@thedoctors.com.

Deceased


References

Jewel JA. Standardization of inpatient handoff communication. Pediatrics. 2016 Nov;138(5).


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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