Handoffs in the Era of Duty Hours Reform

Abstract

With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.

Fostering Creativity

“…• Projects are being shared and published in peer-reviewed venues and academic journals, [9][10][11][12][13][14][15][16][17][18][19][20] and several others are in preparation for submission or awaiting journal decisions. A few institutions have responded by providing seed money to allow teaching faculty time for educational innovation.…”

The Importance of Fostering Ownership During Medical Training

“…There is a consensus that the greater the number of handoffs, the greater the risk for medical errors. In order to mitigate these risks, the study calls for increased supervision and training in handoffs (DeRienzo 2012). Experts suggest that handoff-related risk can be managed by structuring a sign-out process (Bump et al 2011).…”

A Division of Medical Communications in an Academic Medical Center’s Department of Medicine

“…[13][14][15] Handoffs are meant to provide continuity of care and high-quality and safe decision making. Issues related to "patient handoffs" have been the focus of some recent studies.…”

“…Issues related to "patient handoffs" have been the focus of some recent studies. 13 Following a focused review of papers on "handoffs in the era of duty hours reform," DeRienzo et al, 14 Another type of physician-to-physician communication undergoing study is consultation with specialists. 13 However, studies have identified communication errors stemming from inadequate transmission of key pieces of clinical information and data about the patient 13,15 and insufficient faceto-face and/or written communication between cross-covering physicians 14 ; these errors increase the risk of adverse events.…”