Improving residents' handovers through just-in-time training for structured communication

Abstract

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover.During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

Virtual handover of patients in the pediatric intensive care unit during COVID-19 crisis

“…Some of our training residents thought the whole endorsement process does not affect the patient care in the PICU, thinking that this relates more to the PICU senior staff themselves rather than relating to the trainees. This misconception highlights that training residents need more education on how proper endorsement affects the quality of patient care and safety (43). Having all PICU team members share the handover information about a patient’s current situation, assessments, and care recommendations could prevent near misses and adverse events (43).…”

“…This misconception highlights that training residents need more education on how proper endorsement affects the quality of patient care and safety (43). Having all PICU team members share the handover information about a patient’s current situation, assessments, and care recommendations could prevent near misses and adverse events (43). Unfortunately, such vital information does not always pass flawlessly from the previous to the subsequent healthcare providers.…”

The Impact of a Standardized Checklist on Transition of Care During Emergency Department Resident Physician Change of Shift

“…Prior research has demonstrated that omission or distortion of important clinical information occurs during transition of care 5,6,9,11. This study sought to address issues of miscommunication during sign-out through utilization of a standardized checklist.…”

“…If done poorly, sign-outs can have deleterious clinical impact. The Institute of Medicine attributes a substantial proportion of preventable adverse events to communication errors during sign-out 5. These errors are among the root causes of nearly two thirds of potentially significant, preventable adverse clinical outcomes in hospitals 6,7…”

Transitions of Care: Complications and Solutions

“…The Institute of Medicine atributes a substantial proportion of preventable adverse events to communication errors during handover [11]. The Agency for Healthcare Research and Quality identiies handof communication miscues as implicated in surgical errors [12] and as a consequential cause of malpractice claims.…”