Distractions During Resident Handoffs

Anderson, Cristan; Nicksa, Grace A.; Stewart, Lygia

doi:10.1001/jamasurg.2014.2459

Cited by 29 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This complements literature highlighting the statistics associated with specific points within this distubution but may be more useful in clinical and educational practices. Specifically, this information may indicate the most effective time for handoffs and staffing changes by predicting interruptions, which have been shown to be detrimental to patient outcomes and to increase resource utilization [20–22]. Residents and other trainees may benefit by predicting times of high volume for those interested in gaining more clinical experience and lulls in trauma activations to allow for uninterrupted education and didactic activities.…”

Section: Discussionmentioning

confidence: 99%

Identifying temporal patterns in trauma admissions: Informing resource allocation

Stonko

Dennis

Callcut³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundIncreased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity.Study designWe conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013–6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed.Results10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p<0.001). Peak arrival time was centered around evening shift change (6-7pm), but differed based on ED disposition: OR and ICU or Step-Down admissions (p = 0.0007), OR and floor admissions (p<0.0001), and ICU or Step-Down and floor admissions (p<0.0001). Step-Down and ICU arrival times (p = 0.42) were not different. Penetrating injuries peaked later than blunt (p<0.0001). Trauma varies throughout the year; we establish a high incidence trauma season (April to late October). Different mechanisms have varying dependence upon season; Motorcycle crashes (MCCs) have the greatest dependence.ConclusionWe identify new patterns in the temporal and seasonal variation of trauma and of specific mechanisms of injury, including the novel findings that 1) penetrating trauma tends to present at later times than blunt, and 2) critically ill patients requiring an OR tend to present later than those who are less acute and require an ICU or Step-Down unit. These patients present later than those who are admitted to the floor. Penetrating trauma patients arriving later than blunt may be the underlying reason why operative patients arrive later than other patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Identifying temporal patterns in trauma admissions: Informing resource allocation

Stonko

Dennis

Callcut³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…A study of surgical residents on a hepatobiliary service noted that distractions were present in 48% of handovers, characterized by pages, telephone calls, nonrelevant conversations, and general noise; however, although distractions increased the length of the handover process, these distractions did not impact handover quality. 19 In contrast, Nagpal and colleagues found that distractions occurred in one-third of postoperative handovers. Distractions were a major contributor to handover failure, which was defined as incomplete transfer of information and omission of important tasks.…”

Section: Effective Communicationmentioning

confidence: 94%

“…The act of standardizing the process will bring together viewpoints that may not otherwise be recognized, and may be more valuable than the details of the process itself. 19 Some structured tools should be integrated to assist with information transfer, but the use of a checklist or mnemonic is likely more important than which checklist or mnemonic is used.…”

Section: Standardization In Perioperative Handoversmentioning

confidence: 99%

Communication: Is There a Standard Handover Technique to Transfer Patient Care?

Methangkool

Tollinche

Sparling

et al. 2019

International Anesthesiology Clinics

View full text Add to dashboard Cite

Effective communication is integral to patient safety, especially during high-risk periods where patients are transitioning to different care areas or to different providers. However, communication failures continue to occur; The Joint Commission (TJC) reports that the number one cause of anesthesia-related sentinel events is breakdown in communication. 1 The operating room (OR), the postanesthesia care unit (PACU), and the intensive care unit (ICU) are especially vulnerable to communication failures between providers; inadequate communication in the PACU has been shown to affect mortality and morbidity. 2,3 A review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS) indicated failure in communication as the second most common contributing factor to adverse events in recovery units. 4 Indeed, observational studies have shown a direct correlation between poor handover and patient harm. 5 Therefore, the handover process is critical to the safe care of the surgical patient. The handover is a transfer of not only information but also of professional responsibilities across teams. 6 Ideally, a handover report is attended by surgical and anesthesia staff, a nurse, and a PACU or an ICU clinician, and relays information on the patient's history, intraoperative events, and postoperative care plan. According to the American Society of Anesthesiologists, standard of care requires the presence of intraoperative anesthesia staff for monitoring during transport and verbal report. 7 However, beyond this, there is a lack of consistent guidelines; reports are vulnerable to omission of pertinent information. 8 A complete omission of information occurred in 57% of surgical malpractice claims 9 and has

show abstract

“…Handoffs can occur amidst hectic and rushed environments that are less than ideal for a thorough exchange of information [ 21 ]. Busy nurses and physicians often find themselves hurried, distracted, or interrupted when trying to deliver handoffs, all of which constitute barriers to an interaction in which all parties are equally engaged [ 22 ]. Unfocused handoffs result from the lack of a concerted effort by surrounding players to prioritize the process over ambient distractions.…”

Section: Discussionmentioning

confidence: 99%

How does training in anesthesia residency shape residents’ approaches to patient care handoffs? A single-center qualitative interview study

et al. 2018

View full text Add to dashboard Cite

BackgroundHandoffs are a complex procedure whose success relies on mutual discussion rather than simple information transfer. Particularly among trainees, handoffs present major opportunities for medical error. Previous research has explored best practices and pitfalls in general handoff education but has not discussed barriers specific to anesthesiology residents. This study characterizes the experiences of residents in anesthesiology as they learn handoff technique in order to inform strategies for teaching this important component of perioperative care.Methods: In 2016, we conducted a semi-structured interview study of 30 anesthesia residents across all three postgraduate years at a major academic hospital. Interviews were coded by two coders using a grounded theory approach and an iterative process designed to enhance reliability and validity.ResultsResidents cited lack of consistency as a major impediment to proper handoff education. They found the impact of lectures and written materials to be limited. The level of guidance and direction they received from one-to-one attendings was described as highly variable. Residents’ comfort in executing handoffs was heavily dependent on location and situation. They felt that coordination among the parties involved in the handoff was difficult to achieve, causing confusion about the importance of handoffs as well as proper protocol. Finally, residents offered opinions on when handoff education should occur during the residency and had several recommendations for its improving, including standardization of key handoff topics.ConclusionsIn a single center study of anesthesiology resident handoff education, residents exhibited confusion related to a perceived disconnect between the stated importance of effective handoffs and a lack of consensus on proper handoff technique. Standardization of curriculum and framing expectations has the potential to enhance resident handoff training in academic anesthesia departments.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1387-8) contains supplementary material, which is available to authorized users.

show abstract

Distractions During Resident Handoffs

Cited by 29 publications

References 31 publications

Identifying temporal patterns in trauma admissions: Informing resource allocation

Identifying temporal patterns in trauma admissions: Informing resource allocation

Communication: Is There a Standard Handover Technique to Transfer Patient Care?

How does training in anesthesia residency shape residents’ approaches to patient care handoffs? A single-center qualitative interview study

Contact Info

Product

Resources

About