Introduction Recognizing a patient requiring urgent or emergent care and initiating evaluation and management must include elements that support teams working and thinking together. Although team communication strategies exist, a standardized approach for communicating about patients with urgent or emergent conditions is lacking. This simulation was designed to provide first-semester medical students with the opportunity to deliberately practice the foundational teamwork skills required to think as a team while caring for a patient with critical hypoglycemia. Methods Students were introduced to a team huddle that was structured using ISBARR (identify, situation, background, assessment, recommend, recap) to assist in synthesizing gathered information and arriving at a diagnosis and associated care plan. Students practiced in small groups with faculty coaches and then applied the skills learned to two cases of a patient with critical hypoglycemia followed by debriefing. Results Two hundred eight first-semester medical students participated in the simulation course across three campuses. We surveyed a single campus subset of 172 students. One hundred thirty-three students completed a postevent survey. The majority felt that the difficulty of the simulation was appropriate for their educational level (94%) and that the training would be applicable to real-life clinical events (76%) and would improve the quality and safety of care (100%). Survey comments highlighted teamwork and the use of the ISBARR huddle communication tool. Discussion The course provided first-semester medical students with standardized practice of a team-based approach using huddle communication to advance patient care.

Introduction.  Effective communication during the patient handoff process is critical for ensuring patient safety. At our academic medical center, first-year interns complete hand-off training before starting clinical rotations. The purpose of this study was to evaluate a virtual handoff training for residents as an alternative to in-person sessions due to limitations imposed by COVID-19.    Methods.  Fifty residents were administered pre/post surveys to gauge the helpfulness of the training for clinical practice, familiarity and confidence in providing a handoff, and whether they would recommend the virtual format for incoming interns. Additionally, faculty rated the virtual form of the handoff activity, made comparisons to in-person sessions, and assessed the helpfulness of the session for residents in clinical practice.  Results.  Forty-four residents (88%) and 11 faculty (85%) completed surveys. After the training session, residents who received instruction and feedback reported significant improvements in familiarity with the handoff tool and confidence in their handoff abilities (both p< 0.001). Both residents and faculty were satisfied with the virtual format of handoff training. Most faculty felt the virtual platform was comparable to in-person sessions and would recommend ongoing use of the virtual platform when in-person sessions were not possible.  Conclusions. Teaching hospitals mandate resident training to include strategies for a uniform handoff method to avoid medical errors. Adaptation to a virtual platform can be a successful instruction strategy, allowing for didactic and interactive sessions with direct faculty observation and feedback.

BackgroundClinical documentation improvement (CDI) is an increasing part of health system quality and patient care with clinical documentation integrity specialists (CDIS) expanding into daily physician workflow. This integration can be especially challenging for resident teams due to increased team size, lack of documentation experience, and misunderstanding of both CDIS and CDI purpose.ProblemThe University of Kansas Health System Internal Medicine residency programme reported challenges with CDIS and resident workflow integration specifically in navigating and understanding CDIS documentation queries, CDIS interruption of interdisciplinary huddles, and general misunderstanding of CDI and the role of CDIS.MethodsA quality improvement project was undertaken to integrate CDIS more effectively into resident workflow. Combined with a resident debrief session to identify general areas of concern, surveys were administered to internal medicine residents, resident rounding faculty and CDIS team members to identify specific barriers to CDIS–physician integration.InterventionA collective group of CDIS member teams, internal medicine chief residents and faculty physicians was formed. Changes made to the CDI process based on survey feedback included (1) improving formatting of CDIS electronic query templates, (2) standardisation of timing for CDIS verbal queries during interdisciplinary huddles, and (3) development of a resident didactic session focused on the role of CDIS and documentation’s impact on quality, safety and outcomes as related to the hospital, provider and patient.ResultsSurveys completed after implementation showed a positive impact on electronic query template changes and perception of CDIS at interdisciplinary huddles. The didactic curriculum was effective in helping residents understand the role and limitations of CDIS and how documentation affects quality of care.ConclusionCDIS–physician integration into resident teams can occur through a collaborative focus on specific aspects of physician workflow and improving understanding of the impact of CDI on patient safety and quality of care.