Communication Failures During Medical Handoffs

What do you think are the most dangerous moments of a patient’s hospital stay? You may imagine a crowded emergency room or a tense operation. While these situations are certainly risky, the most dangerous times for a hospital patient are during routine medical handoffs. Because these moments happen routinely and frequently, there are more chances that a provider will make a mistake that endangers the patient.

A medical handoff is a transfer of responsibility from one healthcare provider or department to another. Handoffs occur often during most hospital stays. Nurses, nursing assistants, and other support staff change shifts, turning over their patients to fresh faces. Patients may transfer from one department to another, such as from the emergency room to the intensive care unit. When hospitals discharge patients, they may refer them to a specialist or primary care provider for follow-up care.

Every time this happens, critical details about the patient’s care can get lost in the shuffle. Communication failures can lead to medication errors, missed diagnoses, delays in treatment, or even preventable death. Understanding the legal responsibilities of healthcare providers and hospitals can help patients recognize when these failures may be medical malpractice.

Negligence and the Standard of Care

Hospitals and medical systems are complex, offering many specialized medical providers. Numerous medical professionals, including nurses, doctors, specialists, pharmacists, and technicians, work together to care for each patient. Every care provider is legally responsible for providing care that meets the “standard of care.”

This benchmark means every person must use the care and skill of an ordinary professional in their role. Failing to do so is called “negligence.” Mistakes that shouldn’t have happened are often due to negligence. Using proper care and skill can prevent many common mistakes.

Common Communication Failures

Unfortunately, many communication failures occur during handoffs. These can result from an incomplete or incorrect chart. During emergency transfers, personnel may omit or give incorrect instructions or information. Common handoff communication failures include:

• Incomplete information. A doctor may not mention a pending test result, a concern about medication side effects, or the full scope of their treatment plans for a patient. Patients may not disclose a complete and honest medical history or may be unable to communicate with providers.
• Inaccurate records. A patient’s chart should contain a complete record of their diagnosis, treatment, and progress. Chart notes that are incomplete, rushed, inconsistent, or outdated can endanger a patient and set other care providers up to fail. 
• Verbal-only exchanges. All important details should be written in a patient’s chart. Instructions or observations spoken at shift changes without being written down may be forgotten.
• Hierarchy barriers. Nurses, residents, or more inexperienced staff members may hesitate to question or clarify orders from senior physicians or staff members.

All providers must cooperate to fully and accurately document a patient’s care, especially during handoffs. In addition to protecting the patients, ensuring effective communication can help hospitals prevent medical malpractice.

Legal Duties of Hospitals and Medical Providers

Each type of healthcare worker has different duties during handoffs. For example:

• Physicians must clearly document diagnoses, treatment plans, and follow-up needs.
• Nurses must maintain accurate charts and medication records to fully inform the next provider. They must also report changes in patient status and any other relevant care information.
• Residents and trainees must be appropriately supervised and work within their boundaries. Attending physicians responsible for this oversight can be liable if they fail to properly supervise handoffs and ensure accurate communication.
• Specialists must coordinate important patient information with other providers and follow up with patients as appropriate.

In many cases, communication failures are not just individual mistakes. Many are signs of systemic problems, such as chronic understaffing, underqualified providers, or an environment where workers fear punishment or shame.

The Importance of Supervision

Michigan law recognizes that attending physicians, supervising nurses, and hospitals can be responsible when they fail to supervise junior staff or trainees adequately. For example:

• A resident confuses two medications with very similar names and prescribes the wrong one. If no attending physician reviews it, both the resident and supervising physician may be liable.
• A patient develops bedsores after a nursing assistant fails to ensure that the patient is properly bathed and their sheets are changed. If a charge nurse fails to monitor the patient’s condition and supervise the assistant, they may both be liable.
• A junior nurse working for fourteen hours fails to report a patient’s change in condition. The hospital may also be responsible if inadequate staffing or unclear reporting policies played a role.

Supervision helps ensure that critical details are not overlooked during transitions. Failure to provide adequate supervision is the basis of many malpractice claims against hospitals and medical care facilities.

Hospital Liability for Handoff Failures

Under Michigan law, plaintiffs can hold hospitals liable for medical malpractice in two main ways. If a professional employed by the hospital commits malpractice, the hospital is generally liable because employees act as the hospital’s agents. This is called “vicarious liability.” A hospital can also be directly liable if their own policies, staffing, or communication systems fail to meet the duty of care.

Examples of these kinds of systemic failures include:

• Not having standardized handoff protocols.
• Overworking staff to the point where errors are foreseeable.
• Failing to provide electronic medical record systems that allow seamless information sharing.
• Ignoring repeated reports of communication problems.
• Perpetuating an atmosphere of fear and reprisal for reporting mistakes.

In Michigan, plaintiffs may be able to pursue claims against both the individual providers and the hospital when handoff failures cause injuries.

Proving a Michigan Medical Malpractice Case

To recover compensation in a medical malpractice case in Michigan, a plaintiff must prove:

• A provider-patient relationship existed, creating a duty of care.
• The provider or hospital breached that duty by failing to communicate appropriately.
• The breach caused an injury.
• The injury led to damages such as medical bills, lost wages, and pain and suffering.

Expert testimony is usually required to establish why a communication failure was unreasonable under professional standards and how it led to a plaintiff’s injury. Hospitals often defend these cases by arguing that errors were “unavoidable” or that another provider was responsible. An experienced attorney can identify where the system failed and who was responsible.

When To Contact an Experienced Medical Malpractice Attorney

Communication failures during handoffs can mean the difference between recovery and tragedy. In Michigan, both individual providers and hospitals have clear legal duties to ensure patients are accurately and safely transferred. If you or a loved one suffered harm because of a medical handoff failure, you may have legal options. A malpractice attorney can help you understand whether the breakdown was an unavoidable mistake or a breach of duty that Michigan law recognizes as malpractice.