Transfer of Accountability (TOA)

Transfer of Accountability (TOA)

Communication of information between healthcare providers is a fundamental component of patient/client care. According to a study done by the U.S. Joint Commission on Accreditation of Healthcare Organizations in 2003, almost 70% of all sentinel events are caused by breakdown in communication. (Alvarado, K, et al., 2006) It is during the transfer of accountably (sometimes referred to as “transfer of care”) that there is the most significant risk of harm to the patient/client.

It is also the times when breaches in patient/client confidentiality frequently occur. Not only can information that should be passed on be missed or misunderstood, but it may also be generally inappropriate, or inappropriate for certain personnel to hear. It is essential when disclosing personal health information to remember who is in the patient/client’s circle of care. This term is not defined in the 2004 Personal Health Information Protection Act but has been generally accepted to be the healthcare providers who deliver care and services for the primary therapeutic benefit of the patient/client. It also covers related activities such as laboratory work and professional or case consultation with other healthcare providers².

Some organizations have implemented a standardized, evidence-based approach to TOA in order to improve the effectiveness and coordination of communication. Some hospital departments have utilized a checklist type format (e.g., code status, infection control requirements, risk concerns) to ensure that nothing important is overlooked during “shift change”. The CRTO encourages its Members to evaluate their own TOA processes and perhaps customize tools used within their own facility

During a verbal report in the staff lounge, an RT reveals to all those present that a patient/client seen in emergency during the previous shift had been brought in following a failed suicide attempt. The door of the lounge is open and nursing staff coming to and from work are passing by in the hallway. In addition, the patient/client is the relative of the Ultrasound Technician, who happens to be in the staff lounge when report is being given. What ethical values/principles have been violated and what steps could have been taken to prevent this from happening?

The ethical principles involved are to do good and do no harm.

The RT giving report has shown a lack of respect for the dignity of the patient/client in question. Also, the patient/client’s confidentially has been violated, as the information was not disclosed in a manner that prevented those outside the individual’s circle of care from being privy to it. Every effort needs to be made to ensure the information shared at handover is accurate, complete and that the risk of inappropriate disclosure of personal health information is minimized.

An RT is currently working part time at one hospital and casual at another. One evening, they needed to leave prior to shift change, in order to arrive on time for their shift at the other facility, but the RT that is relieving them had not arrived yet. If they have gotten permission from their employer to leave early, is it permissible to do so according to the CRTO?

The ethical principles involved are to do good and do no harm.

The RT is responsible for providing respiratory care up to the point of the transfer of
accountability and must be physically present to provide a verbal report, unless there are other organizational mechanisms in place. This situation has the potential for significant risk (e.g., The second RT is delayed in arriving for their shift).

The fact that your employer permits something is only one part of the equation. As a regulated healthcare professional, your ultimate accountability is to your patients.


2. Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety.