In a recent study from Brigham and Women’s Hospital, a web-based handoff tool used by inpatient medical and surgical services was associated with a reduction in medical errors.
Medical errors are a major problem in modern healthcare, highlighted more than a decade ago by an Institute of Medicine report. Using health IT to target some high-risk tasks that lead to error, like manual data transfer between different systems or handwritten medication orders, can be helpful.
In this study, researchers looked at the rate of medical errors before and after implementation of a web-based handoff tool for medical and surgical housestaff. This handoff tool automatically pulled in patient information, typically things like medical history and medications, in addition to clinician-entered information. In addition, they made updating the handoff a more structured, consistent activity by housestaff, trained housestaff on using the handoff, and provided handoff training that included weekly supervised handoffs with feedback.
To measure medical errors, they used a validated questionnaire administered to housestaff at the end of each shift during the study period. The questionnaire was administered before the web-based handoff tool was launched, after it was launched, and again a year later (same time of year as the pre-intervention survey but new academic year). Of note, between surveys 2 and 3, the medical teams were restructured so that each team was assigned a single unit. While that approach does have its limitations, it can still offer useful insights especially when comparing within-group.
They found a reduction in medical errors from 3.56 per 100 patient-days to 1.76 per 100 patient-days (p<0.001), adjusted for patient factors such as age, length of stay, and DRG code. The reduction in errors that were felt to cause harm was not statistically significant (0.49 to 0.26 per 100 patient days, p=0.22). They also noted that medical errors were reduced between survey 2 and 3, suggesting the floor-based medical team approach may have had additional benefit worth studying further.
While health IT systems like EHRs are often criticized for pulling clinicians away from the bedside, this study nicely highlights how an appropriately designed health IT tool can improve communication and perhaps even improve outcomes. While far from conclusive, the results are encouraging and will hopefully support further studies and refinement in these tools to help improve care and reduce errors.