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

Abstract

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.

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance

“…Each behavior was chosen after careful review and deliberation of well-publicized work in this area, 16,[19][20][21] previously validated tools to evaluate handoffs such as the Hand-off CEX, 22 and the recommendations for handoffs outlined by the Society of Hospital Medicine. 23 Four of these behaviors were directly taken from the Handoff CEX.…”

Transitions of Care: Complications and Solutions

“…Detecting discrepancies between levels of quality of handof communication requires training and is made more complicated by the existence of few standardized methods for assessing the competency of sign-out communication [3,10,24]. Horwiz et al developed an evaluation tool for direct observation of house staf and hospitalists during sign out that generates quantiiable data of handof assessment and performs consistently across diferent institutions and among both trainees and atendings [24]. Horwiz et al utilized peers to conduct handof assessments, reasoning that peers familiarity with the handof issues would recognize miscues that external evaluators might miss [24].…”

“…Horwiz et al developed an evaluation tool for direct observation of house staf and hospitalists during sign out that generates quantiiable data of handof assessment and performs consistently across diferent institutions and among both trainees and atendings [24]. Horwiz et al utilized peers to conduct handof assessments, reasoning that peers familiarity with the handof issues would recognize miscues that external evaluators might miss [24]. Starmer et al, as part of their standardized sign-out bundle, developed direct observation assessment tools for assessment of quality of the departing and oncoming clinicians' adherence to the components of their handof protocol and verbal engagement with one another [19].…”

Standardization of Inpatient Handoff Communication

“…Studies have challenged the typical belief that handoffs between physicians are efficient and effective 12 and that handoffs between experienced providers are better than between trainees. 13 Although all transitions of care benefit from appropriate handoffs, this clinical report aims to guide shift-change communication for inpatient handoffs between providers of the same service. The report also aims to improve patient care by identifying best practices for physicians who provide direct clinical care to pediatric patients in the inpatient or critical care unit.…”