(HealthDay News) — Biased patient handoffs impede accurate transfer of key clinical information among medical trainees, according to a study published online Dec. 17 in JAMA Network Open.
Austin Wesevich, M.D., M.P.H., from the University of Chicago, and colleagues assessed the impact of biased language in simulated verbal handoffs on recipient clinical information recall and attitude toward patients. The analysis included survey results from 142 residents in internal medicine, pediatrics, and internal medicine-pediatrics and 27 senior medical students at two academic medical centers.
The researchers found that participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77 versus 93 percent). Further, those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85 versus 93 percent). After receiving biased versus neutral handoffs, participants had less positive attitudes toward patients per Provider Attitudes Toward Sickle Cell Patients Scale scores (mean scores, 22.9 versus 25.2). Higher clinical information recall accuracy was associated with more positive attitudes toward patients (odds ratio, 1.12).
“These results further support standardization of handoffs as called for by multiple organizations, critical to reducing biased language that can negatively impact clinicians’ perceptions of patients and reduce retention of key clinical information needed for patient care,” the authors write.
Patient handoffs and the potential for bias
Patient handoffs, also known as handovers or transfers of care, are critical moments in healthcare when responsibility for a patient’s care transitions from one healthcare provider or team to another. These transitions occur frequently in various settings, such as shift changes, transfers between units (e.g., ICU to general ward), or transitions between healthcare facilities. Effective handoffs are essential for ensuring patient safety, preventing medical errors, and maintaining continuity of care.
A well-structured patient handoff typically involves the transfer of key information, including:
- Patient demographics and identifiers: Name, date of birth, medical record number.
- Current medical status: Diagnosis, active problems, vital signs, allergies, and current treatments.
- Recent events: Significant events that occurred during the previous shift or period of care.
- Pending tests and results: Any outstanding laboratory results, imaging studies, or other diagnostic tests.
- Care plan and goals: Current treatment plan, goals of care, and any specific instructions or precautions.
- Code status: Whether the patient has a Do Not Resuscitate (DNR) order or other advance directives.
- Family/social context: Relevant social or family information that may impact care.
Several standardized handoff methods have been developed to improve communication and reduce errors. However, even with standardized protocols, bias can significantly impede effective patient handoffs.1 Bias, in this context, refers to unconscious or implicit attitudes, stereotypes, or prejudices that can affect our perceptions and judgments about individuals or groups. Several types of bias can negatively impact handoffs:
- Confirmation bias: The tendency to seek out and interpret information that confirms pre-existing beliefs. For example, if a provider believes a patient is “drug-seeking,” they may downplay or dismiss legitimate complaints of pain.
- Anchoring bias: The tendency to rely too heavily on the first piece of information received. In a handoff, if the initial report is incomplete or inaccurate, subsequent providers may be anchored to that information, leading to misdiagnosis or mistreatment.
- Implicit bias related to race, ethnicity, gender, socioeconomic status, or other social categories: These biases can lead to differential treatment based on group membership. For instance, a provider may subconsciously spend less time with a patient from a lower socioeconomic background, leading to a less thorough handoff and potentially poorer care.
- Framing bias: How information is presented can influence how it’s received. If a patient is described as “difficult” or “non-compliant,” it can create a negative frame that biases subsequent providers’ interactions and assessments.
These biases can manifest in several ways during handoffs:
- Incomplete or inaccurate information transfer: Providers may subconsciously omit or downplay information about patients they perceive negatively.
- Differential communication styles: Providers may use different tones of voice, body language, or levels of engagement when communicating about patients from different groups.
- Reduced empathy and rapport: Bias can hinder the development of rapport and empathy, making it harder for providers to understand the patient’s perspective and needs.
Mitigating the impact of bias in patient handoffs requires a multi-faceted approach. This includes raising awareness of implicit bias through training and education, implementing standardized handoff protocols, promoting a culture of psychological safety where providers feel comfortable speaking up, and encouraging active listening and respectful communication. By addressing bias and promoting effective communication, healthcare systems can significantly improve the safety and quality of patient care during transitions.