How to Stop Overnight Communication Errors at Your Hospital

By Lisa Mulcahy via Multibriefs

Overnight shift workers at your hospital face unique challenges when it comes to effectively consulting each other. These issues can impact patient safety.

From the sleep-deprived intern trying to ask the right diagnostic questions to optimum consultations strategies, you want to make sure your staff is always communicating wisely and effectively.

The good news: these science-proven strategies can help cut confusion, refocus concentration and ensure accuracy. Use these strategies to make your overnight policies foolproof:

Standardize consult criteria.

Researchers from Massachusetts General Hospital found that pediatric residents on call often wait to consult their superiors in situations where those supervisors want to know of changes immediately. For example, residents know they should immediately call their superiors if there is a patient death, quick downgrade of condition, or a medical error.

They may wait, however, to report that they put a patient in restraints or that they are dealing with aggressive behavior by a patient. Many supervisors want to know of these issues in real time.

Outline criteria clearly so that your residents and physicians are always on the exact same page.

Ask your radiologists to triple-check their work.

An intriguing study from the University of Utah found that on-call radiologists who are interrupted by phone calls don't make more diagnostic mistakes but often shift their attention away from what they were looking at specifically before they were interrupted.

To absolutely ensure accuracy, especially on overnight shifts where fatigue can be an issue, ask your radiologists to do three checks of their work before signing off on a case. The extra few minutes this takes is worth it.

Minimize overnight handoffs.

Research from the American College of Surgeons found that surgical residents who take less time off between shifts than is allowed by U.S. standards do not pose any greater risk to patients. However, handoffs during surgery, which can happen if a resident suddenly has to leave the OR due to duty hour limits — can pose a patient safety risk, due to a new doctor needing to get immediately up to sped on what is happening mid-procedure.

Always respect duty hour requirements, but also schedule overnight shifts so residents do not have to leave their patients at critical times.

Enforce those naps.

Staff members on overnight shifts should be reminded to nap strategically as much as they can. This is an obvious tip, but a crucial one — even a little sleep can help refresh a resident who needs to ask a patient being admitted overnight the right questions regarding symptoms.

Don't focus your efforts just on the weekends.

Some administrators may try to cut communication error risk by raising staffing levels on Saturday and Sunday. This could conceivably cut down on "the weekend effect" — the theory that patent death rates rise on those days.

According to research published in The Lancet, this doesn't address overall staff communication errors that can happen any night of the week. (Or day, for that matter.)

A staff meeting in which you ask for input regarding ongoing communication problems is the best way to identify overall problem areas. Furthermore, solve them with the feedback of all your healthcare workers!

Lisa Mulcahy is an internationally established health writer whose credits include the Los Angeles Times, Redbook, Glamour, Elle, Cosmopolitan, Health, Good Housekeeping, Parade, Woman's Day, Family Circle and Seventeen. She is the author of eight best-selling books, including "The Essentials of Theater," an Amazon No. 1 new release.