• Establish relationships and develop a communication plan for the timely transfer of information among other providers: what, when, how, and to whom

  • Communicate with co-managing providers directly (in person or by phone) whenever possible and document the method of communication

  • Use effective techniques and tools that confirm accurate and timely transfer of information (closed-loop communication)

  • Be sure that laboratory and diagnostic test results are sent to the appropriate providers

  • In a hospital or other inpatient setting, conduct hand-offs in a quiet, private, distraction-free location


  • Leave messages or send test results without confirming that they were received and reviewed by the appropriate provider(s)

  • Leave the patient in the dark about any aspect of their care, including test results

  • Depend on a third party, such as a nurse or receptionist, to deliver a message or test result without ensuring that the information was received by the intended recipient

  • Assume that the primary care physician or person who ordered a test is the only person who will be held responsible for a communication error in the event of an adverse patient outcome

  • Allow tiredness, a full schedule, or distractions to interfere with the quality of information exchanged during a patient hand-off 

If you’re interested in case-based education for healthcare providers related to inter-provider communication and hand-offs, please contact us at

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