Simple Standardized Patient Handoff System that Increases Accuracy and Completeness

Wayne, Jeffrey D.; Tyagi, R. K.; Reinhardt, Gilles; Rooney, Deborah M.; Makoul, Gregory; Chopra, Sunil; DaRosa, Debra A.

doi:10.1016/j.jsurg.2008.06.011

Cited by 119 publications

(62 citation statements)

References 25 publications

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“…Findings include: (1) problematic shift models common to residency programs in the US undermine direct physician communication and increase the number of handoffs, reducing the quality of the verbal handoff [6][7][8][9] ; (2) written handoffs are wrought with variability and content omissions 7 ; (3) electronic templates can mitigate handoff problems. 10,11 The aforementioned research has led to several recommendations for interventions to improve handoffs. 1,2,5,6,[12][13][14] The few published intervention studies have not examined patient safety events as outcomes, leading experts to question the utility of standardization of handoffs as a patient safety initiative.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

et al. 2013

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BACKGROUND: Poor quality handoffs have been identified as a major patient safety issue. In residency programs, problematic handoffs may be an unintended consequence of duty-hour restrictions, and key data are frequently omitted from written handoffs because of the lack of standardization of content. OBJECTIVE: Determine whether an intervention that facilitates face-to-face communication supported by an electronic template improves the quality and safety of handoffs. DESIGN: Before-after trial. PARTICIPANTS: Thirty-nine interns providing nighttime coverage over 132 intern shifts, representing ∼9,200 handoffs. INTERVENTIONS: Two interventions were implemented serially-an alteration of the shift model to facilitate face-to-face verbal communication between the primary and nighttime covering physicians and an electronic template for the day-to-night handoff. MEASUREMENTS: Overall satisfaction and handoff quality were measured using a survey tool administered at the end of each intern shift. Written handoff quality, specifically the documentation of key components, was also assessed before and after the template intervention by study investigators. Interns used the survey tool to report patient safety events related to poor quality handoffs, which were validated by study investigators. RESULTS: In adjusted analyses comparing intern cohorts with similar levels of training, overall satisfaction with the new handoff processes improved significantly (p<0.001) post intervention. Verbal handoff quality (4/ 10 measures) and written handoff quality (5/6 measures) also improved significantly. Study investigators also found significant improvement in documentation of key components in the written handoff. Interns reported significantly fewer reported data omissions (p=0.001) and a non-significant reduction in near misses (p=0.056), but no significant difference in adverse events (p=0.41) post intervention.

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Section: Discussionmentioning

confidence: 99%

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

et al. 2013

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“…3,[11][12][13][14][15] The first form, called the Ten Tasks List (see Appendix available online), was a checklist of ten individual outstanding patient care tasks to be addressed by the intern within the first 3 months of the academic year. Patient care tasks were limited to the following five categories: (1) laboratory, (2) radiology, (3) medication, (4) specialist consultation, and (5) advance directives.…”

Section: Transfer Of Care Structure and Processmentioning

confidence: 99%

Development of a Structured Year-End Sign-Out Program in an Outpatient Continuity Practice

et al. 2012

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BACKGROUND:In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relatively few studies conducted in the outpatient setting. OBJECTIVES: To develop a structured transfer of care program in an academic outpatient continuity practice and evaluate whether this program improved patient safety as measured by the documented completion of patient care tasks at 3 months post-transition. DESIGN: Graduating residents and the corresponding incoming interns inheriting their continuity patient panels were randomized to the pilot structured transfer group or the standard transfer group. The structured transfer group residents were asked to complete written and verbal sign-outs with their interns; the standard transfer group residents continued the current standard of care. PARTICIPANTS: Thirty-two resident-intern pairs in an academic internal medicine residency program in New York City. MAIN MEASURES: Three months after the transition, study investigators evaluated whether patient care tasks assigned by the graduating residents had been successfully completed by the interns in both groups. In addition, follow-up appointments, continuity of care and house officer satisfaction with the sign-out process were evaluated. KEY RESULTS: Among patients seen during the first 3 months, the clinical care tasks were more likely to be completed by interns in the structured group (73 %, n= 49) versus the standard group (46 %, n=28) (adjusted OR 3.21; 95 % CI 1. 55-6.62; p=0.002). This was further enhanced if the intern who saw the patient was also the assigned primary care provider (adjusted OR 4.26; p=0.002). CONCLUSIONS: A structured outpatient sign-out improved the odds of follow-up of important clinical care tasks after the year-end resident clinic transition. Further efforts should be made to improve residents' competency with regard to sign-outs in the ambulatory setting.KEY WORDS: patient safety; transfer of care; handoff; sign-out; continuity of care.

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“…8 Standardized handoff forms have improved accuracy of information. 9 Web-based signout systems reportedly reduced the number of patients missed on rounds. 10 Hospitalists also face challenges with effective communication during service change.…”

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confidence: 99%

Gaining efficiency and satisfaction in the handoff process

Burton

Kashiwagi

Kirkland

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians‐in‐training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.METHODS:An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in‐room conversations), and poor communication. The team restructured the process and observed post‐intervention behavior at 15 and 90 days. A participant‐provider survey was conducted before and after the intervention regarding wasted time, total time‐in‐report, and satisfaction with the process.RESULTS:Pre‐intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post‐intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre‐intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post‐intervention (P < 0.0001).CONCLUSIONS:This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non‐clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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Simple Standardized Patient Handoff System that Increases Accuracy and Completeness

Cited by 119 publications

References 25 publications

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

Development of a Structured Year-End Sign-Out Program in an Outpatient Continuity Practice

Gaining efficiency and satisfaction in the handoff process

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