Need for Standardized Sign‐out in the Emergency Department: A Survey of Emergency Medicine Residency and Pediatric Emergency Medicine Fellowship Program Directors

Sinha, Madhumita; Shriki, Jesse; Salness, Rebecca; Blackburn, Paul

doi:10.1197/j.aem.2006.09.048

Cited by 38 publications

(19 citation statements)

References 16 publications

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“…Previous literature has revealed that few trainees receive formal training in effective hand-off communication 2,12 despite the ubiquitous nature of this task performed by interns in every specialty. The lack of trainee preparation on how to perform hand-offs impacts a number of stakeholders, including residency program directors 13 .…”

Section: Aimmentioning

confidence: 99%

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

et al. 2009

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AIM:The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students' sign-out skills using a real-time assessment tool, the Hand-off CEX.SETTING: Thirty-two 4th year medical students participated as part of an elective course.PROGRAM DESCRIPTION: One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video. PROGRAM EVALUATION:Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the "Mini-CEX," which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre-and poststudent self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4-9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post-vs. 27% prereporting 'well-prepared,' p<0.009).DISCUSSION: This brief, standardized hand-off training exercise improved students' confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument. 129 SETTINGThe OSHE was a module in a month-long skills-based "Transitions to Internship" elective course offered to graduating students in April of their final year of medical school. Thirty-four students who had matched into nine different specialties participated in the course. This elective focuses specifically on "orphan" topics not addressed elsewhere in the curriculum. Topics include procedural skills, preparedness for life as a resident, advanced communication skills (e.g., obtaining informed consent and disclosing medical error) and personal life preparedness (e.g., debt management and maintaining work/life balance). PROGRAM DESCRIPTIONStudents participated in a 90-min interactive workshop on communication skills necessary to perform effective handoffs (see online Appendix A). This module, delivered by one of the authors (VA), discussed communication theory as it relates to effective hand-off communication. Key points communicated during this workshop included: the importance of face-to-face communication, encouraging questions from the hand-off receiver, providing detailed "to-do" lists with rationale and anticipatory guidance. The instructor included case-based examples on the importance of effective hand-offs both in medicine and other industries 20 .The components of a written hand-off were discussed during the 90-min hand-off training, and students were given a representative example of a high-quality written sign-out 21 .Finally, students were provided with electronic access to the workshop materials and a...

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Section: Aimmentioning

confidence: 99%

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

et al. 2009

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“…3,[6][7][8] Yet, the process of teaching physician handoffs between specialties is not well described in the emergency medicine (EM) literature. 6,[9][10][11][12] No best practice recommendations exist and there is no universally taught, standardized handoff format that emergency physicians use for patient care. 10 Situation-Background-Assessment-Recommendation (SBAR) provides a framework for effective communication among members of the health care team.…”

Section: Introductionmentioning

confidence: 99%

Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills

Tews¹,

Liu²,

Treat³

2012

Journal of Graduate Medical Education

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Background To date, no standardized presentation format is taught to emergency medicine (EM) residents during patient handoffs to consulting or admitting physicians. The Situation-Background-Assessment-Recommendation (SBAR) is a common format that provides a consistent framework to communicate pertinent information. Objective The objective of this study was to describe and evaluate the feasibility of using SBAR to teach interphysician communication skills to first-year EM residents to use during patient handoffs. Methods An educational study was designed as part of a pilot curriculum to teach first-year EM residents handoff communication skills. A standardized SBAR reporting format was taught during a 1-hour didactic intervention. All residents were evaluated using pretest/posttest simulated cases using a 17-item SBAR checklist initially, and then within 4 months to assess retention of the tool. A survey was distributed to determine resident perceptions of the training and potential clinical utility. Results There was a statistically significant improvement from the resident scores on the pretest/posttest of the first case (P = .001), but there was no difference between posttest of the first case and pretest of the second case (P = .34), suggesting retention of the material. There was a statistically significant improvement from the pretest and posttest scores on the second case (P = .001). The survey yielded good reliability for both sessions (Cronbach alpha = 0.87 and 0.89, respectively), demonstrating statistically significant increases for the perceived quality of training, presentation comfort level, and the use of SBAR (P = .001). Conclusion SBAR was acceptable to first-year EM residents, with improvements in both the ability to apply SBAR to simulated case presentations and retention at a follow-up session. This format was feasible to use as a training method and was well received by our resident physicians. Future research will be useful in examining the general applicability of the SBAR model for interphysician communications in the clinical environment and residency training programs.

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“…73 A survey of emergency residency programs revealed that 75% had no formal didactic training and 90% had no written policy about ToCs. 9 Numerous organizations, including The Joint Commission 74 76 The ACGME, a professional organization responsible for the accreditation of numerous residency education programs, requires specific attention to ToC procedures in both residency and fellowship training programs, creating common standards for all training programs. 77 The American Association of Colleges of Nursing also includes knowledge of and ability to perform appropriate ToC practices as a competency for graduate nursing.…”

Section: Teaching Tocsmentioning

confidence: 99%

“…8 In addition to the need for more evidence gathering, surveys of graduate medical education program directors have concluded that there is a perceived need for emergency medicine and pediatric emergency medicine training programs to provide specific guidance to trainees regarding ToC processes. 9 A new clinical report from the …”

Section: Introductionmentioning

confidence: 99%

Handoffs: Transitions of Care for Children in the Emergency Department

Shook¹,

Chun²,

Conners³

et al. 2016

Pediatrics

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Transitions of care (ToCs), also referred to as handoffs or sign-outs, occur when the responsibility for a patient's care transfers from 1 health care provider to another. Transitions are common in the acute care setting and have been noted to be vulnerable events with opportunities for error. Health care is taking ideas from other high-risk industries, such as aerospace and nuclear power, to create models of structured transition processes. Although little literature currently exists to establish 1 model as superior, multiorganizational consensus groups agree that standardization is warranted and that additional work is needed to establish characteristics of ToCs that are associated with clinical or practice outcomes. The rationale for structuring ToCs, specifi cally those related to the care of children in the emergency setting, and a description of identifi ed strategies are presented, along with resources for educating health care providers on ToCs. Recommendations for development, education, and implementation of transition models are included.

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Need for Standardized Sign‐out in the Emergency Department: A Survey of Emergency Medicine Residency and Pediatric Emergency Medicine Fellowship Program Directors

Abstract: There is wide variation in the sign-out processes followed by different EDs. A majority of those surveyed expressed the need for standardized sign-out systems.

Cited by 38 publications

References 16 publications

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents' Learning of Case Presentation Skills

Handoffs: Transitions of Care for Children in the Emergency Department

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