Resident Sign-Out and Patient Hand-Offs: Opportunities for Improvement

Bump, Gregory M.; Jovin, Franziska; Destefano, Lindsay; Kirlin, Amanda; Moul, Andrew; Murray, Kelly; Simak, Deborah; Elnicki, D. Michael

doi:10.1080/10401334.2011.561190

Cited by 25 publications

(32 citation statements)

References 18 publications

(14 reference statements)

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“…Faculty oversight, review of handoff content, and feedback resulted in statistically significant content error reductions and correction of content that could have led to a serious patient safety issue; therefore, we recommend the 17,29,33,53 N Persistence of inaccurate data 19,29,33,34,37,44 N Clinician resistance to change 31,46,47,50 N Perception that the handoff tool might interfere with direct physician communication 26,40,41 N Duplication of work or more work 17,32 N Errors created by free-text entry 54 use of faculty oversight and real-time feedback of resident handoffs in medical education.…”

Section: Discussionmentioning

confidence: 99%

“…26 An observational study found that that only 11% included ''Do Not Resuscitate'' or advance directive information, and only 50% of successive handoffs were updated daily. 53 Another study found that 96% of electronic handoffs were updated within 24 hours, 51 while a third study found an increase in the documentation of 12 of 16 specific data elements studied, a decrease in 3 elements, and no difference in 1 element. 48 Three studies noted that an electronic handoff tool should include free-text options for current anticipatory guidance and comments, 25,35,48 and another reported that users need to be encouraged to be vigilant in revising and updating free-text sections.…”

Section: Process Measuresmentioning

confidence: 99%

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Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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Background Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. Objective This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. Methods We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. Results Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. Conclusions The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.

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Section: Discussionmentioning

confidence: 99%

Section: Process Measuresmentioning

confidence: 99%

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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“…search, we identified 26 articles (32 tools) published between January 1, 2008, and May 13, 2015, that focused on inpatient handoff feedback or assessment tools (FIGURE). Of these articles, 3 were relevant to feedback only, 2 7 , 2 9 , 34 8 to assessment only, 15,18,19,21,23,31,33,35 and 15 to feedback and assessment (TABLES 1 and 2). 16,17,20,22,[24][25][26]28,30,32,[36][37][38][39][40] Copies of some tools are available from the authors on request.…”

Section: Types Of Data Reportedmentioning

confidence: 99%

“…15,17,24,28,30,32,33,[36][37][38][39] Other study designs inc l u d e d va li d i t y e vi d e n ce o n l y (6 o f 2 6 , 23%) 19,21,26,29,31,35 ; randomized control trial (2 of 26, 7.7%) 16,25 ; posttest study (2 of 26, 7.7%) 20,40 ; observational study (2 of 26, 7.7%) 18,23 ; and matched group design with random assignment to control and trained groups (1 of 26, 3.8%). 22 The studies included the specialties of internal medicine (12 of 26, 46%) 15,16,18,19,[23][24][25][26][27]31,34,37 ; pediatrics (3 of 26, 12%) 33,38,39 ; pediatric cardiac critical care (1 of 26, 3.8%) 21 ; surgery (1 of 26, 3.8%) 29 ; emergency medicine (1 of 26, 3.8%) 36 ; and gastroenterology (1 of 26, 3.8%). 40 Several of the studies used participants from more than 1 specialty (7 of 26, 27%).…”

Section: Types Of Data Reportedmentioning

confidence: 99%

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Feedback and Assessment Tools for Handoffs: A Systematic Review

Davis

Roach

Elliott

et al. 2017

Journal of Graduate Medical Education

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Development of a handoff evaluation tool for shift‐to‐shift physician handoffs: The handoff CEX

Horwitz

Rand²,

Staisiunas

et al. 2013

Journal of Hospital Medicine

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Background Increasing frequency of shift-to-shift handoffs coupled with regulatory requirements to evaluate handoff quality make a handoff evaluation tool necessary. Objective To develop a handoff evaluation tool Design Tool development Setting Two academic medical centers Subjects Nurse practitioners, medicine house staff and hospitalist attendings Intervention Concurrent peer and external evaluations of shift-to-shift handoffs. Measurements The Handoff CEX consists of 6 subdomains and one overall assessment, each scored from 1–9, where 1–3 is unsatisfactory and 7–9 is superior. We assessed range of scores, performance among subgroups, internal consistency, and agreement among types of raters. Results We conducted 675 evaluations of 97 unique individuals during 149 handoff sessions. Scores ranged from unsatisfactory to superior in each domain. The highest rated domain for handoff providers was professionalism (median 8, interquartile range [IQR] 7–9); the lowest was content (median 7, IQR 6–8). Scores at the two institutions were similar, and scores did not differ significantly by training level. Spearman correlation coefficients among the CEX sub-domains for provider scores ranged from 0.71–0.86, except for setting (0.39–0.40). Third-party external evaluators consistently gave lower marks for the same handoff than peer evaluators did. Weighted kappa scores for provider evaluations comparing external evaluators to peers ranged from 0.28 (95% CI, 0.01–0.56) for setting to 0.59 (0.38–0.80) for organization. Conclusions This handoff evaluation tool was easily used by trainees and attendings, had high internal consistency and performed similarly across institutions. Because peers consistently provided higher scores than external evaluators, this tool may be most appropriate for external evaluation.

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Resident Sign-Out and Patient Hand-Offs: Opportunities for Improvement

Abstract: We found variability in the content and organization of interns' sign-out, possibly reflecting a lack of instruction and supervision. Standardization of sign-out content, and education on good sign-out skills are increasingly important as patient hand-offs become more frequent.

Cited by 25 publications

References 18 publications

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Feedback and Assessment Tools for Handoffs: A Systematic Review

Development of a handoff evaluation tool for shift‐to‐shift physician handoffs: The handoff CEX

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