Transfers of Patient Care Between House Staff on Internal Medicine Wards

Horwitz, Leora I.; Krumholz, Harlan M.; Green, Michael L.; Huot, Stephen J.

doi:10.1001/archinte.166.11.1173

Cited by 257 publications

(189 citation statements)

References 39 publications

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“…5 Several studies have identified flaws in the handoff process and potential targets for intervention. 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.…”

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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“…We conducted interviews using a discussion guide (see online Appendix) that explores experiences and perspectives towards quality and safety in the discharge process and was informed by recent qualitative studies of residents' perspectives on other quality and safety practices. 13,14,20 Interviews were conducted in June 2010 and January 2011 to sample resident perspectives at two different points in time. Participants were entered into a lottery for one of three $100 gift cards at each site as an incentive to participate.…”

Section: Study Design and Samplementioning

confidence: 99%

“…10 Recent duty hour regulations 11,12 have also heightened these challenges and drawn increased attention to transitions of care at teaching hospitals. 13 Although studies of inpatient transitions, such emergency departmentto-floor 14 or dayshift-to-nightshift handoff practices for inpatient units, 15,16 have already informed curricular changes at residency programs, 17 we have very limited data about resident practices at the point of discharge. Recently, we described quality-limiting factors in discharge care at teaching hospitals; however, information is still lacking about how residents learn to provide high-quality discharge care.…”

Section: Introductionmentioning

confidence: 99%

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

et al. 2012

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BACKGROUND: Reducing readmissions and post-discharge adverse events by improving the quality of discharge care has become a national priority, yet we have limited understanding about how physicians learn to provide high-quality discharge care. METHODS: We conducted in-depth, in-person interviews with housestaff physicians with qualitative analysis by a multi-disciplinary team using the constant comparative method to explore learning about highquality discharge care as a systems-based practice and to identify opportunities to improve training around these concepts. RESULTS: We analyzed interview transcripts from 29 internal medicine residents: 17 (59 %) were interns (PGY-2 or PGY-3), 12 (41 %) seniors, and 17 (59 %) were female. We identified a recurrent theme of lack of formal training about the discharge process, substantial peerto-peer instruction, and "learning by doing" on the wards. Within this theme, we identified five specific concepts related to systems-based practice and highquality discharge care which residents learned during residency: (1) teamwork and the interdisciplinary nature of discharge planning; (2) advanced planning strategies to anticipate challenges in the discharge process; (3) patient safety and the concept of a "safe discharge;" (4) patient continuity of care and learning from post-discharge outcomes and; (5) documentation of discharge plans as a valuable skill. CONCLUSIONS: Discharge care is an overlooked opportunity to teach concepts of systems-based practice explicitly as learning about discharge care is unstructured and individual experiences may vary considerably. Educational interventions to standardize learning about discharge care may improve the development of systems-based practice during residency and help improve the overall quality of discharge care at teaching hospitals.KEY WORDS: discharge care; quality of care; core competencies; residency education.

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“…One publication describes baseline handover procedures 27 . ACGME has yet to begin annual site visits.…”

Section: Individual Requirementsmentioning

confidence: 99%

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

Nuckols

Escarce

2011

J GEN INTERN MED

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Transfers of Patient Care Between House Staff on Internal Medicine Wards

Abstract: Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.

Cited by 257 publications

References 39 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

“Learning by Doing”—Resident Perspectives on Developing Competency in High-Quality Discharge Care

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

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