Improving Handoff Communications in Critical Care*: Utilizing Simulation-Based Training Toward Process Improvement in Managing Patient Risk

Berkenstadt, Haim; Haviv, Yael; Tuval, Atalia; Shemesh, Y; Megrill, Alexander; Perry, Amir; Rubin, Orit; Ziv, Amitai

doi:10.1378/chest.07-0914

Cited by 53 publications

(71 citation statements)

References 23 publications

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“…The first category -handover content -has been mostly descriptive, concentrating on the completeness and accuracy of information (Arora et al 2005, Berkenstadt et al 2008, Horwitz et al 2009a. These studies typically showed verbal handover to be incomplete compared with the information available in the patient's record (Lamond 2000, Arora et al 2007 or compared with a pre-defined handover protocol (Catchpole et al 2007).…”

Section: Assessing Handover Qualitymentioning

confidence: 99%

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

Drach‐Zahavy

Hadid

2015

Journal of Advanced Nursing

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Section: Assessing Handover Qualitymentioning

confidence: 99%

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

Drach‐Zahavy

Hadid

2015

Journal of Advanced Nursing

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“…Other single-site studies have shown standardized physician handoffs decrease "per-patient" handoff time, decrease handoff-related missed/inaccurate information, and improve communication. 10,11 With these few exceptions, however, studies linking standardized handoff processes to decreased patient harm are rare, and limited multicenter and pediatric research has been performed.…”

mentioning

confidence: 99%

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Bigham¹,

Logsdon

Manicone³

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.METHODS: Twenty-three children' s hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS:Twenty-three children' s hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P , .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P , .05]; clear transition of responsibility from 92% to 96% [P , .05]; and minimized interruptions and distractions from 84% to 90% [P , .05]) as did overall satisfaction with the handoff (from 55% to 70% [P , .05]).CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children' s hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Pediatrics 2014;134: e572-e579 AUTHORS:

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“…The development of the instrument for peer evaluation of handoffs was informed by reviewing published handoff best practices 7,8,21 and handoff assessment instruments 22,23 as well as the six ACGME core competencies, particularly those requiring peer evaluations (communication, professionalism and systems-based practice) 9 for internal medicine residency programs. The institution's patient safety experts, residency program leadership and housestaff reviewed the instrument for content validity.…”

Section: Development Of the Peer Evaluation Instrumentmentioning

confidence: 99%

“…5 Best handoff communication practices have been published 6,7 and medical educators are developing innovative curricula to teach and evaluate handoff skills. 6,[8][9][10][11][12][13][14] The ability to capture handoff errors is limited by common barriers to safety reporting. 15,16 Additionally, since post-graduate year 1 (PGY1) trainees and post-graduate year 2-3 (PGY2-3) trainees typically handoff or "sign-out" to their peers, traditional evaluations by supervisors may be inadequate for assessing handoff skills.…”

Section: Introductionmentioning

confidence: 99%

Using Peers to Assess Handoffs: A Pilot Study

et al. 2013

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BACKGROUND: Handoffs among post-graduate year 1 (PGY1) trainees occur with high frequency. Peer assessment of handoff competence would add a new perspective on how well the handoff information helped them to provide optimal patient care. OBJECTIVE: The goals of this study were to test the feasibility of the approach of an instrument for peer assessment of handoffs by meeting criteria of being able to use technology to capture evaluations in real time, exhibiting strong psychometric properties, and having high PGY1 satisfaction scores. DESIGN: An iPad® application was built for a sevenitem handoff instrument. Over a two-month period, post-call PGY1s completed assessments of three coPGY1s from whom they received handoffs the prior evening. PARTICIPANTS: Internal Medicine PGY1s at the University of Pennsylvania. MAIN MEASURES: ANOVA was used to explore interperson score differences (validity). Generalizability analyses provided estimates of score precision (reproducibility). PGY1s completed satisfaction surveys about the process. KEY RESULTS: Sixty-two PGY1s (100 %) participated in the study. 59 % of the targeted evaluations were completed. The major limitations were network connectivity and inability to find the post-call trainee. PGY1 scores on the single item of "overall competency" ranged from 4 to 9 with a mean of 7.31 (SD 1.09). Generalizability coefficients approached 0.60 for 10 evaluations per PGY1 for a single rotation and 12 evaluations per PGY1 across multiple rotations. The majority of PGY1s believed that they could adequately assess handoff competence and that the peer assessment process was valuable (70 and 77 %, respectively). CONCLUSION: Psychometric properties of an instrument for peer assessment of handoffs are encouraging. Obtaining 10 or 12 evaluations per PGY1 allowed for reliable assessment of handoff skills. Peer evaluations of handoffs using mobile technology were feasible, and were well received by PGY1s.

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Improving Handoff Communications in Critical Care*: Utilizing Simulation-Based Training Toward Process Improvement in Managing Patient Risk

Abstract: Simulation-based training can be incorporated into the risk management process and can contribute to patient safety practice.

Cited by 53 publications

References 23 publications

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Using Peers to Assess Handoffs: A Pilot Study

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