A Simulation Study on Handoffs and Cross-coverage: Results of an Error Analysis

Handoffs and cross-coverage are necessary for maintaining the continuity of patient care, yet both are potential sources of error, and may threaten patient safety and care. Handoffs are the transfer of patient information and accountability from one provider to another. Cross-coverage is the management of patients, of whom physicians who have little or no prior knowledge of, during nightshifts. We observed how physicians give a sign-out after receiving a handoff in a simulated session of an evening handoff and start of nightshift. We collected data from thirty physicians from an academic medical center as they signed out six patients after responding to nurse calls. An error analysis of the sign-out data revealed 42 errors overall, with 28 omissions and 14 "erroneous data" errors. We then propose ways to prevent these errors through modification of the electronic medical record and support tools, and through higher awareness of human factors.