Sustainability and Effectiveness of a Quality Improvement Project to Improve Handoffs to Night Float Residents in an Internal Medicine Residency Program

Yazıcı, Cemal; Abdelmalak, Hany D.; Gupta, Shanu; Shmagel, Anna; Albaddawi, Eman; Tsang, Vivian; Potts, Steven; Arora, Vineet M.

doi:10.4300/jgme-d-12-00175.1

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…Similarly, Graham et al 104 reported improvements in the quality of written accounts of five out of six measures. Yazici et al 103 noted an improvement in five quality markers, but this was sustained to 9 months for only three of them. Gonzalo et al 108 also found limited benefits after 12 months, with no improvement in eight measures of communication and a worsening in communication of results of completed studies/consults.…”

Section: Standardised Handover Toolmentioning

confidence: 98%

“…Whether or not this translates into better patient outcomes is not known; despite the majority of studies showing a positive benefit, most of the studies were of poor quality and were small, uncontrolled before-and-after studies. [95][96][97][98][100][101][102][103][104][105][106][107][108][109] Continuing education is the most challenging of the four interventions to assess in terms of the quality and quantity of evidence available. There is some evidence of improved knowledge and self-reported confidence in a range of skills, as well as in process measures, such as frequency of observations, but the evidence for improved patient outcomes is weak.…”

Section: Main Findingsmentioning

confidence: 99%

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Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

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BackgroundUnchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time.ObjectiveTo determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes.DesignA mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals).SettingEnglish hospitals participating in the NCAA audit.ParticipantsNHS staff (approximately 300) and patients (13 million).InterventionsEducation, track-and-trigger systems (TTSs), standardised handover tools and outreach teams.Main outcome measuresIHCA rates, survival and hospital-wide mortality.Data sourcesNCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics.MethodsA literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15).ResultsAcross NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival.LimitationsThe organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall.ConclusionsStandardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival.Future workTo assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Standardised Handover Toolmentioning

confidence: 98%

Section: Main Findingsmentioning

confidence: 99%

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

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“…15 Appropriate techniques to identify problems, create solutions, and evaluate long-term effects are central elements for the success and sustainability of any QI intervention, including handoffs. 27 The findings from this study may not necessarily generalize to other handoff implementation venues with different organizational structures and characteristics (eg, large medical centers). This limitation notwithstanding, the findings from this study provide a guiding framework for small and rural hospitals interested in learning from experiences of other similar hospitals that have implemented handoff.…”

Section: Discussionmentioning

confidence: 73%

Critical Access Hospital Use of TeamSTEPPS to Implement Shift-Change Handoff Communication

Natafgi

Zhu²,

Baloh³

et al. 2017

Journal of Nursing Care Quality

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Implementation of handoff as part of TeamSTEPPS ® initiatives for improving shift-change communication is examined via qualitative analysis of on-site interviews and process observations in 8 critical access hospitals. Comparing implementation attributes and handoff performance across hospitals shows that the purpose of implementation did not differentiate between high-and low-performance, but facilitators and barriers did. Staff involvement and being part of the 'big picture' was an important facilitator to change management and buy-in. Keywordscritical access hospitals; communication; Handoff; quality improvement; rural; TeamSTEPPS Since the release of the prominent Institute of Medicine (IOM) report on quality of care and patient safety in US hospitals in 2000, hospitals are increasingly adopting quality improvement (QI) strategies to enhance their performance and facilitate safer patient care. 1

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“…3,4 However, most protocols are developed from brainstorming and consensus instead of from empirical data. Although some evidence suggests that using standardized handoff protocols are better than not using standardized protocols, [5][6][7][8][9] to our knowledge, no studies directly compare 2 different protocols to each other. Considering that protocol use is increasingly common practice, a more pertinent question is which protocol is more effective?…”

mentioning

confidence: 99%

Directly Comparing Handoff Protocols for Pediatric Hospitalists

Lazzara

Riss²,

Patzer

et al. 2016

Hospital Pediatrics

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Sustainability and Effectiveness of a Quality Improvement Project to Improve Handoffs to Night Float Residents in an Internal Medicine Residency Program

Abstract: We demonstrated sustained improvements in unreported events and uncertainty caused by poor handoffs. Initial improvements in missed content and copy-and-paste behavior that were not sustained suggest a need for ongoing reinforcement and monitoring of handoff quality.

Cited by 13 publications

References 13 publications

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Critical Access Hospital Use of TeamSTEPPS to Implement Shift-Change Handoff Communication

Directly Comparing Handoff Protocols for Pediatric Hospitalists

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