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Pass Protection For Patients

Pediatrician Carolyn Roy-Bornstein worries about critical patient info getting lost between shifts

Dr. Carolyn Roy-Bornstein is a Haverhill-based pediatrician who writes about health care. Here, she considers the hazards of the “patient pass-off” — when patients are handed from one resident to another at the end of a shift, and critical medical information can fall through the cracks:

For anyone who has followed the New England Patriots and their beloved quarterback Tom Brady all these years, the disastrous 28-21 trouncing by the New York Jets in the recent play-off game was a real stab in the heart. The Jets managed to sack our QB five times last Sunday, despite the Patriots’ history of pitch-perfect pass protection.

While drowning my sorrows in a bucket of Buffalo chicken wings and ruminating on this concept of “pass protection,” I started thinking about another kind of “pass-off.” That is: the “patient pass-off,” also called sign-out. Patient sign-out occurs in teaching hospitals when one resident’s shift ends and another begins. Interns try to convey crucial information about a patient’s care: what is happening with the patient, what needs to be followed up on. When I was a resident sign-out happened just once a day: when the end of one 24-hour-on resident’s shift collided with next’s. But with recent changes in residency duty hours, information sign-out between residents has become more frequent.

In 2003, the Accreditation Council for Graduate Medical Education restricted residents’ working hours in response to concerns about resident sleep deprivation and its effect on patient safety. In 2008 the Institution of Medicine curtailed resident work hours even further. With this restriction, the number of patient hand-offs increased. Continue reading