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Change of nursing shifts, units, and facilities present challenges for continuity of care Contact Now

Learn the three times that a hospitalized patient's care can fall through the cracks

Change of nursing shifts, units, and facilities present challenges for continuity of care

I’ve learned from handling countless medical malpractice cases at Painter Law Firm that one of the weak points in patient safety is any time there is a transition in care.

Change of nursing shifts

For hospitalized patients, the most frequent transition in care is the change of nursing shifts.

Most hospitals have 12-hour nursing shifts. Registered nurses often work from 7:00 AM to 7:00 PM, or 7:00 PM to 7:00 AM. All of the knowledge about each patient’s status that should have been collected by the outgoing nurse needs to be transferred to the oncoming nurse.

So many things fall through the cracks at this critical time that health care leaders have developed a concept called the handoff communication.

Handoff communications are basically briefings where an outgoing shift nurse orients a new bedside nurse to the patient’s name, reason for hospitalization, any problems that came up during the prior shift, orders that are in place, lab and radiology results that are pending, and other findings from assessments and reassessments that are important to the patient’s care.

As a former hospital administrator, I think the best practice for handoff communications is to have them done in the patient room, preferably with the patient participating, or at least listening to, the handoff communication. I see this as sort of a safety net, giving the patient an opportunity to speak up if something significant is left out of the handoff communication.

Moving units in the same hospital

Another common transition within the hospital occurs when a patient is transferred from one unit to a different unit. This could happen when a patient is hospitalized on a regular floor and is moved to the intensive care unit (ICU) or a step-down unit.

When a patient arrives at a new unit, there’s a new nursing staff that is entirely dependent on what was documented or communicated to them by the nurses who were previously involved in the patient’s care.

With the flurry of activity around moving a patient from one unit to another, pending physician orders can fall through the cracks, as can communication of critical lab results or radiology findings.

Transferring facilities

Another area of transition in care where things can go wrong is when a patient is transferred from one facility to another.

There are two distinct areas where I’ve seen opportunities for significant system failures regarding transfer records.

First, the standard care requires the transferring facility nursing staff to send a copy of patient records to the accepting facility. Doctors and nurses refer to the set of records as the transfer records. I’ve seen many cases where the completeness—I should say incompleteness—of the transfer records is shocking. When significant clinical information about the patient is missing, there can be a disruption in the continuity of care, meaning that the patient may go days without proper medications and treatment while the new healthcare team is getting up to speed.

Second, most hospitals, skilled nursing facilities, and rehabilitation centers use electronic medical record software. Transfer records almost always are sent in paper form. In many cases, physicians and nurses simply aren’t used to dealing with paper records and that alone can cause information to fall through the cracks.

Interestingly, in working on a current Houston, Texas medical malpractice lawsuit, I learned that a major flagship hospital in Houston’s Texas Medical Center doesn’t even scan transfer records into the patient’s electronic medical records for weeks or months.

What you can do

I encourage every patient to ask to be involved in handoff communications and the transfer of care process, whether it’s within one hospital or when being transferred to a different facility.

Sometimes healthcare providers and patients forget that patients are an important part of the healthcare team.

To improve your safety as a patient, either you or a family member should keep notes about the course of your health care and condition, including pending orders and outstanding radiology or test results. When you’re transferred to the care of a new nurse, new unit, or new facility, don’t make the presumption that new doctors and nurses are familiar with what’s happened in your care. Speak up and be an active participant in your healthcare.

If you’ve been seriously injured because of poor communication among your doctors and nurses, or any type of poor healthcare, then contact a top-rated experienced Houston medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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