Initial assessment of patient handoff in accredited general surgery residency programs in the United States and Canada: a cross-sectional survey

Abstract

Background: Communication errors are considered one of the major causes of senti nel events. Our aim was to assess the process of patient handoff among junior surgical residents and to determine ways in which to improve the handoff process. Methods:We conducted nationwide surveys that included all accredited general surgery residency programs in the United States and Canada.Results: Of the 244 American and 17 Canadian accredited surgical residency pro grams contacted, 65 (27%) and 12 (71%), respectively, participated in the survey. Of the American and Canadian respondents, 66% and 69%, respectively, were from post graduate year (PGY) 1, and 32% and 29%, respectively, were from PGY 2; 85 (77%) and 50 (96%), respectively, had not received any training about patient handoff before their surgical residency, and 27% and 64%, respectively, reported that the existing handoff system at their institutions did not adequately protect patient safety. More over, 29% of American respondents and 37% of Canadian respondents thought that the existing handoffs did not support continuity of patient care. Of the American resi dents, 67% and 6% reported receiving an incomplete handoff that resulted in minor and major patient harm, respectively. These results mirrored those from Canadian resi dents (63% minor and 7% major harm). The most frequent factor reported to improve the patient handoff process was standardization of the verbal handoff. Conclusion:Our survey results indicate that the current patient handoff system con tributes to patient harm. More efforts are needed to establish standardized forms of verbal and written handoff to ensure patient safety and continuity of care.Contexte : Les erreurs de communication sont considérées comme l'une des causes majeures des événements sentinelles. Notre but était d'évaluer le processus de trans fert des patients chez les résidents junior en chirurgie et de trouver des façons de l'améliorer.Méthodes : Nous avons procédé à des sondages nationaux qui ont inclus tous les programmes agréés de résidence en chirurgie générale aux États Unis et au Canada.Résultats : Sur les 244 programmes agréés de résidence en chirurgie américains et les 17 canadiens, 65 (27 %) et 12 (71 %), respectivement, ont participé au sondage. Parmi les participants américains et canadiens, 66 % et 69 %, respectivement, étaient en pre mière année de résidence (PGY 1) et 32 % et 29 %, respectivement, étaient en deux ième année de résidence (PGY 2); 85 (77 %) et 50 (96 %), respectivement, n'avaient reçu aucune formation sur le transfert des patients avant leur résidence en chirurgie et 27 % et 64 %, respectivement, ont déclaré que le système actuel de transfert de leur établissement n'assurait pas adéquatement la sécurité des patients. De plus, 29 % des participants américains et 37 % des participants canadiens ont dit estimer que le mode actuel de transfert ne favorisait pas la continuité des soins. Chez les résidents américains, 67 % et 6 % ont déclaré recevoir un rapport de transfert incomplet susceptible d'entraîner u...

Meta-Analyses of the Effects of Standardized Handoff Protocols on Patient, Provider, and Organizational Outcomes

“…To illustrate, 80% of severe medical errors were attributed to miscommunication during handoffs (Joint Commission, 2012b). Specifically, poor communication during handoffs can lead to delayed and missed diagnoses (Lorincz et al, 2011), litigation and malpractice claims (Gandhi et al, 2006; Singh, Thomas, Petersen, & Studdert, 2007), omitted patient information (Devlin, Kozij, Kiss, Richardson, & Wong, 2014), diagnostic testing errors (Murphy, Singh, & Berlin, 2014), treatment delays (Horwitz, Moin, Krumholz, Wang, & Bradley, 2008), patient harm (Arora, Johnson, Lovinger, Humphrey, & Meltzer, 2005; Kitch et al, 2008; Saleem, Paulus, Vassiliou, & Parsons, 2015), and mortality (American Thoracic Society, 2016). Despite handoffs being vulnerable to communication breakdowns, they are an essential, frequent part of routine medical care.…”

The surgical journey: exploring the OR-PACU handover

“…Surgical members, particularly fellows and residents seemed unsure about their role during the handover, about what was expected, or what information they needed to provide. Findings from Saleem, Paulus, Vassiliou and Parsons (2015) suggest that the majority (77-96%) of general surgical residents, in the American and Canadian residency program, do not receive any training on patient handover prior to starting their surgical residency. Participants in this study shared similar concerns and discussed lack of role modeling and handover training in the medical curriculum.…”

How to Improve Patient Handoff Quality for Ensuring Patient Safety: A Systematic Review

“…Thus, handoff training program must be continually conducted to perform a consistent patient handoff [1]. [6] reported that handoff process supervision can improved handoff consistency.…”

“…Errors in handoff process can lead to communication failure that can impact to missing transfer information and resulted in patient's harm. Barriers in handoff process must be addressed to improve the quality of the process.The most common reason for incomplete patient handoff that resulted in minor and major harm was that the verbal handoff received didn't contain the most current information about the patient[6]. Inaccurate information in handoff process can be resulted from human factors (knowledge, culture, fatigue), organization culture (lack of teamwork and leadership, blaming culture), lack of training, no standardized tools, patient-related factors, and environment (chaotic environment, noise, high risk and high volume environment, numerous of comorbid conditions)[4,5].…”

“…Improved satisfaction on written handoff process was measured by the completion of written handoff content, number of missing information, and identifying the clinical priorities. Significant fewer reported data omissions but non-significant reduction in near misses and no significant difference in adverse events were also reported.Lack of staff training and handoff supervision and monitoring are also potential barriers to a consistent handoff process[6]. Leadership and regulation support are needed to provide the consistency of handoff training and supervision and to improve the continuity of handoff process[7].…”