How Hospital Shift Changes Contribute To Medical Errors And Patient Harm

Hospitals operate around the clock, which means responsibility for a patient’s care regularly passes from one group of doctors, nurses, and other medical professionals to another. These transitions, commonly called handoffs or handovers, are a necessary part of hospital care. However, they can also create opportunities for serious mistakes.

Why Are Hospital Shift Changes A Patient-Safety Risk?

A patient’s care can involve numerous healthcare professionals. Doctors, nurses, specialists, pharmacists, technicians, and other providers may all be involved, and important information can accumulate quickly.

When shifts change, incoming providers have to be aware of what happened before they arrived and what requires their attention next. A proper handoff often includes various information, including:

• The patient’s diagnosis and current condition
• Recent changes in symptoms or vital signs
• Medications and dosages
• Allergies and adverse drug reactions
• Pending laboratory tests and imaging
• Abnormal test results requiring follow-up
• Recent procedures or surgeries
• Consultations that have been requested
• Changes in the treatment plan
• Warning signs that require close monitoring
• Tasks that have not yet been completed

When that information is incomplete or inaccurate, the incoming provider may not realize that a patient’s condition requires immediate attention. The risk may be particularly significant for patients whose conditions are rapidly changing. Someone who appeared stable several hours earlier may require urgent intervention by the time another team assumes responsibility for the patient’s care.

What Types Of Medical Errors Can Occur During A Handoff?

Communication failures during shift changes can contribute to many different types of medical errors.

One of the most dangerous is a delay in diagnosis or treatment. For example, an outgoing provider may know that a patient’s symptoms are worsening or that a serious condition is suspected. If that concern is not clearly communicated, the incoming team may not appreciate the urgency of the situation.

Medication mistakes can also occur. A provider may fail to communicate that a medication was discontinued, that a dosage was changed, or that a patient experienced an adverse reaction. The next provider could then administer an incorrect medication or dosage.

Other potential handoff-related errors may include:

• Failure to follow up on abnormal laboratory results
• Failure to review imaging results
• Missed or delayed specialist consultations
• Failure to monitor a patient’s deteriorating condition
• Failure to recognize signs of infection or sepsis
• Delayed treatment of stroke or heart attack symptoms
• Failure to respond to abnormal vital signs
• Duplicate medications or treatments
• Failure to administer necessary medication
• Inappropriate discharge
• Failure to communicate complications following surgery

Sometimes no single mistake appears catastrophic on its own. Rather, several small communication failures may combine to create a serious breakdown in care.

How Can Shift Changes Contribute To A Failure To Diagnose?

Consider a patient who arrives at an emergency department complaining of dizziness, weakness, and difficulty walking.

The first physician orders diagnostic tests but ends their shift before all results are available. The patient’s care is transferred to another physician.

If the incoming doctor does not receive a clear explanation of the symptoms, neurological concerns, and pending tests, the significance of an abnormal result may be overlooked. The patient could potentially be discharged while experiencing a stroke or another serious neurological condition.

Similar scenarios can occur with infections, internal bleeding, heart attacks, pulmonary embolisms, and other conditions in which timely diagnosis is critical.

The fact that a shift change occurred does not excuse a failure to provide appropriate medical care. Hospitals and healthcare professionals should have procedures in place to ensure that patient responsibility is transferred safely.

Are Hospitals Responsible For Preventing Handoff Errors?

Hospitals play an important role in developing policies and procedures that promote safe transitions in patient care. Procedures can be used to make handoffs more consistent and reduce the likelihood of important information being lost.

Hospitals must also consider adequate staffing and workload. When doctors and nurses are responsible for too many patients or are rushing to complete a handoff, the risk of important information being missed may increase.

A hospital malpractice investigation involving a communication breakdown may therefore look beyond the actions of one doctor or nurse. Attorneys may need to examine the hospital’s policies, staffing, training, and systems for transferring responsibility between providers.

When Does A Shift-Change Error Become Medical Malpractice?

Not every communication mistake results in medical malpractice, and a poor medical outcome does not automatically mean someone was negligent.

Generally, a medical malpractice case requires evidence that a healthcare provider failed to meet the accepted standard of care and that the failure caused the patient additional injury or harm.

In a case involving a hospital handoff, important questions may include:

• What did the outgoing healthcare provider know?
• What information was communicated to the incoming provider?
• Was critical information omitted or inaccurately conveyed?
• Were there abnormal test results that required follow-up?
• Who was responsible for reviewing pending results?
• Did the hospital have an appropriate handoff procedure?
• Did healthcare professionals follow that procedure?
• When did the patient’s condition begin to deteriorate?
• Would appropriate communication and earlier intervention probably have changed the outcome?

Answering those questions often requires much more than reviewing the final discharge summary. Attorneys and medical experts may need to reconstruct the patient’s treatment minute by minute using medical records, nursing notes, laboratory results, imaging, medication records, and other evidence.

What Injuries Can Result From Hospital Communication Failures?

The consequences depend heavily on the patient’s underlying condition and the nature of the information that was missed.

A delay in recognizing sepsis, for example, may allow an infection to progress and cause organ damage. A missed stroke can result in additional brain injury and permanent neurological disability. Failure to communicate signs of internal bleeding following surgery may lead to severe blood loss or death.

Other consequences may include:

• Brain damage
• Permanent neurological injuries
• Organ failure
• Amputation
• Cardiac injury
• Worsening infection
• Additional surgery
• Extended hospitalization
• Long-term rehabilitation
• Permanent disability
• Wrongful death

The central question in a malpractice case is not simply whether communication could have been better. It is whether a preventable breakdown in communication caused or contributed to additional injury.

How Can Ross Feller Casey Help With Hospital Malpractice?

Hospital communication cases can be difficult to investigate because the mistake may not be obvious from a single medical record. The experienced medical malpractice lawyers at Ross Feller Casey understand how to investigate complex hospital negligence cases. The firm’s team includes nationally recognized physicians, some of whom are also attorneys, who can review medical records and help determine whether the care provided met accepted medical standards.

Ross Feller Casey has recovered billions of dollars for injured clients, including numerous multimillion-dollar verdicts and settlements in cases involving shift-change errors.

If you or a loved one suffered serious harm and you believe a communication failure or hospital shift change may have contributed, contact Ross Feller Casey for a free case review. An experienced hospital malpractice attorney can review what happened and help determine whether you may have a claim.

Ross Feller Casey handles medical malpractice cases on a contingency-fee basis, which means you pay no attorney’s fee unless the firm obtains a financial recovery in your case.