Hospital shift changes ripe for errors

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On this first weekend of the NFL season, handoffs and fumbles will happen. Unfortunately, handoffs and fumbles also happen in the hospital.

Patient handoffs occur during nursing shift changes and because several physicians may be responsible for care. Handoffs also occur when patients are transferred to another hospital or unit. During the handoff, the new health care practitioner is supposed to receive comprehensive instructions. But the Agency for Healthcare Research and Quality says this changeover in care responsibilities "creates opportunities for error." The agency notes the potential for errors has grown since 2003, when regulations limiting the number of duty hours for some hospital staff were implemented.

What can you do? Noting that handoffs often occur outside the patient's room, a hospital safety brief from the World Health Organization advises patients and family members to ask to be involved during handoffs when possible. If something doesn't sound right during the instructions, speak up.

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