Transfer of Care:Weakest Link in Critical Care

Numerous studies have demonstrated that transfer of care of a critically ill patient takes place most frequently in the Intensive care unit of any busy hospital. Communication is particularly important but vulnerable to error during times of transition or a ''hand-off'' from one healthcare professional to another. Several studies conducted so far have highlighted failure of communication between health care personnel as a major threat to patient safety in critical care. These failures also account for over 60% of ischolar_main causes of sentinel events as reported to the Joint Commission on Accreditation of Healthcare Organizations. Hand off refers to transfer of heath care form one provider to the other. The transfer could mean transfer of information, responsibility or authority from one clinician to the other. Burton and Eaton et al have defined Hand off as verbal and written communication between health care professionals as they transition between work shifts or transfer of primary responsibility of care from one person to other. In the present era of exploding technology and super specialization, it is not only inescapable but also necessary to give the patient the best in health care that is available. This involves frequent transfers. These transfers can involve hand off within a health care set up from one clinician to the other, during duty shift changes or transfers from one institute to the other. The unaware patientis exposed to a complex health care environment which has been undergoing a dynamic change. Adding onto this are variations in clinical practice in various departments within the same health care set up. To provide seamless and uninterrupted health care there should be continuity of information, management and also relations. Previous studies have aimed to define the characteristics of a "handoff in a variety of settings and contexts such as nursing shift report, ambulance to hospital transfer, and emergency medicine shift changes. Despite all efforts there ts a lot that needs to be achieved. To overcome the hand off barrier certain key strategies have been proposed. They include incorporation, standardization and universal implementation of hand off tools, holding frequent education sessions for health care providers as well other stake holders so that hand off becomes smooth and error free. Computer technology can be utilized to incorporate online forms, check lists. It can also provide a structure to guide health care providers when it comes to sharing relevant and critical information.