Effects of Education on Interns' Verbal and Electronic Handoff Documentation Skills

Abstract

Communication errors can cause preventable health care adverse events. Some of these errors occur when physicians handoff their patients' care.1 Resident duty hour limitations have fragmented inpatient care and increased handoff frequency.2 Communication failures during handoffs are well described, with lack of standardization and inadequate training in handoff skills having been implicated as contributing factors.3,4 The Institute of Medicine 5 has responded by recommending resident training in handoff communications. Therefore, developing ways to teach and improve resident handoff quality is a goal for educators.Although various strategies to improve handoff quality have been described, 6 relatively few studies have tested whether teaching residents handoff skills improves handoff quality.7 Our primary aim was to determine the effectiveness of handoff education on the quality of interns' electronic and verbal handoffs by comparing the handoff quality of interns who received education to those who did not. Secondary outcomes included communication failures reported by handoff receivers, environmental handoff behaviors, and changes in interns' knowledge and attitudes regarding handoffs. AbstractBackground Improving handoff communications is a National Patient Safety Goal. Interns and residents are rarely taught how to safely handoff their patients. Our objective was to determine whether teaching safe handoff principles would improve handoff quality.

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

“…While several methods of teaching and evaluating handoffs have been previously described in the literature, 16,19,20,24,25 this study is the first to utilize a multi-patient, simulation-based assessment targeting incoming residents. Our results suggest that this may be a promising strategy to provide continuity in handoff training during the transition from undergraduate to graduate medical education and to identify incoming residents in need of additional practice.…”

Using Peers to Assess Handoffs: A Pilot Study

“…Much of the current handoff education literature has focused on observations of a verbal handoff or grading a written or electronic handoff." 14,22,23,25 While this approach can help ensure that certain elements are consistently handed off (e.g., which patients are sick and need closer attention), the peer evaluation adds a new and important perspective, that of the receiving PGY1, who can assess how well the handoff information helped them to provide optimal patient care. Notably, the overwhelming majority of PGY1s believed a co-PGY1 was best able to evaluate their handoff skills.…”

“…Feedback has been shown to be effective in many aspects of medical education 24 and has recently been used as a teaching strategy in handoff education 23,25 and has been shown to improve handoff skills. 14,22 By evaluating handoff practices in real time, the possibility for immediate and timely feedback arises, which has been shown to be more effective than delayed feedback. 26,27 Most feedback is typically provided to trainees by their supervisors -PGY2-3s and attending physicians.…”

“…The development of the instrument for peer evaluation of handoffs was informed by reviewing published handoff best practices 7,8,21 and handoff assessment instruments 22,23 as well as the six ACGME core competencies, particularly those requiring peer evaluations (communication, professionalism and systems-based practice) 9 for internal medicine residency programs. The institution's patient safety experts, residency program leadership and housestaff reviewed the instrument for content validity.…”

Feedback and Assessment Tools for Handoffs: A Systematic Review

“…Of these articles, 3 were relevant to feedback only, 2 7 , 2 9 , 34 8 to assessment only, 15,18,19,21,23,31,33,35 and 15 to feedback and assessment (TABLES 1 and 2). 16,17,20,22,[24][25][26]28,30,32,[36][37][38][39][40] Copies of some tools are available from the authors on request.…”