Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions

Abstract

IntroductionThe Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions.MethodsUsing a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio-recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes.ResultsED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools).ConclusionKey participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015

“…A total of 434 papers and abstracts satisfied the search criteria, and 61 papers met the inclusion criteria . The authors scored these 61 manuscripts, and the 10 highest scoring quantitative and two qualitative articles are reviewed below, in alphabetical order by first author's last name.…”

“…Notably, four of these were articles highlighted for excellence and represent 15% of the featured studies. Six studies (10%) involved qualitative methodology of which two were highlighted . There were 10 papers (16%) that employed survey methodology but none met the criteria for a highlighted article .…”

“…The study populations included medical students (36%), residents (54%), and a variety of others (attending physicians, nurses, interprofessional teams, fellows, midlevel providers, paramedics, validity evidence, and department flow).…”

“…As usual, some articles focused on pediatric topics . The importance of communication was studied in 13 (21%) of studies, marking a drastic increase over past years . The popularity of clinical reasoning studies waned this year with only two studies (3%) .…”