Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign‐out

Vidyarthi, Arpana R.; Arora, Vineet M.; Schnipper, Jeffrey L.; Wall, Susan D.; Wachter, Robert M.

doi:10.1002/jhm.103

Cited by 252 publications

(195 citation statements)

References 34 publications

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“…1,2 These errors can result in adverse events, longer hospital-stays, and increased use of medical resources. [3][4][5][6][7] In 2011, the Accreditation Council of Graduate Medical Education (ACGME) required that all residency programs implement a structured handoff protocol and develop a plan to monitor handoff quality.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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BACKGROUND: Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking. AIM: Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance. SETTING: Graduate Medical Education (GME) orientation at an urban, academic medical center. PARTICIPANTS: Eighty-four incoming residents from four residency programs participated in the study. PROGRAM DESCRIPTION: The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally Bhanded off^three mock patients of varying acuity and were evaluated by a trained Breceiver^using an expertinformed, five-item checklist. PROGRAM EVALUATION: Prior handoff experience in medical school was associated with higher checklist scores (23 % none vs. 33 % either third OR fourth year vs. 58 % third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12 % no training vs. 38 % prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting. CONCLUSIONS: The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.KEY WORDS: medical education; medical student and residency education; communication skills.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…4,5 This has led to calls for improved education and standardization of the handoff process for IM residents. [6][7][8] One of the most important components of an effective handoff is being able to convey the acuity of a patient's illness. 8 In particular, being able to identify which patients are at risk for clinical deterioration is an integral piece of this communication.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] One of the most important components of an effective handoff is being able to convey the acuity of a patient's illness. 8 In particular, being able to identify which patients are at risk for clinical deterioration is an integral piece of this communication. The ability to differentiate "sick" from "not sick" is one of the important features distinguishing an intern from an upper-level resident.…”

Section: Introductionmentioning

confidence: 99%

Predicting and Communicating Risk of Clinical Deterioration: An Observational Cohort Study of Internal Medicine Residents

et al. 2014

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BACKGROUND: Despite its importance, little is known about internal medicine (IM) residents' ability to assess and communicate a patient's overnight risk during the resident-to-resident handoff. OBJECTIVE: To evaluate IM residents' ability to identify patients at risk for clinical deterioration using the Patient Acuity Rating (PAR) tool (scored on a 1-7 symmetric scale; 1="Extremely unlikely", 7="Extremely likely"), and to measure how well IM residents conveyed a patient's potential for clinical deterioration during day-to-night handoff. DESIGN AND PARTICIPANTS: Observational cohort study of 46 postgraduate year 1 (PGY-1) and 32 postgraduate year 3 (PGY-3) internal medicine residents rotating on one of four general medicine services from October 2013 through January 2014. MAIN MEASURES: Primary outcomes were (1) level of agreement between resident handoff giver and receiver regarding patients' clinical risk and (2) accuracy of resident-assigned PAR score in predicting a patient's risk of clinical deterioration over the subsequent 24 hours. KEY RESULTS: Analysis of PGY-1 giver-receiver handoff agreement revealed an intraclass correlation coefficient (ICC) (95 % CI) of 0.51 (0.45-0.56), while PGY-3 giverreceiver agreement yielded an ICC (95 % CI) of 0.42 (0.36-0.47). Based on 865 ratings of 378 patients, PGY-1 handoff giver PAR scores of 5 and 6+ were significantly associated with increased odds of clinical deterioration within 24 hours (aOR=6.5 and 12.4; P=0.03 and 0.005, respectively). For the 1,170 PAR ratings of 438 patients assigned by PGY-3 handoff givers, PAR scores of 4, 5, and 6+ were significantly associated with increased odds of an event within 24 hours (aORs=6.0, 9.6, and 18.1; P=0.03, 0.01, and 0.0008, respectively). CONCLUSIONS: The PAR is a useful tool to quantify IM residents' judgment of patient stability, and may be particularly valuable during resident handoff, given that the level of agreement between giver and receiver regarding patient risk is only fair.

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“…2,3 Recognizing such findings, a growing body of literature addresses handoff techniques for learners. [4][5][6][7] Vidyarthi described the handoff process as ''traditionally informal, unstructured, and idiosyncratic,'' 4 and many believe efforts to formalize and structure this process are important for patient safety. 8 Standardized handoff forms have improved accuracy of information.…”

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confidence: 99%

Gaining efficiency and satisfaction in the handoff process

Burton

Kashiwagi

Kirkland

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians‐in‐training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.METHODS:An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in‐room conversations), and poor communication. The team restructured the process and observed post‐intervention behavior at 15 and 90 days. A participant‐provider survey was conducted before and after the intervention regarding wasted time, total time‐in‐report, and satisfaction with the process.RESULTS:Pre‐intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post‐intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre‐intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post‐intervention (P < 0.0001).CONCLUSIONS:This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non‐clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign‐out

Cited by 252 publications

References 34 publications

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

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

Predicting and Communicating Risk of Clinical Deterioration: An Observational Cohort Study of Internal Medicine Residents

Gaining efficiency and satisfaction in the handoff process

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