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Guldner G, Wells J, Ayutyanont N, Iyengar R, Sprenger S, Siegel JT, Kashyap R. COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents. MEDICAL EDUCATION ONLINE 2023; 28:2143307. [PMID: 36369921 PMCID: PMC9665094 DOI: 10.1080/10872981.2022.2143307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.
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Affiliation(s)
- Gregory Guldner
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | - Jessica Wells
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | | | - Rahul Iyengar
- Southern Hills Medical Center, TriStar Division, HCA Healthcare, Nashville, TN, USA
| | - Steven Sprenger
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
| | - Jason T. Siegel
- Department of Behavioral and Organizational Science, Claremont Graduate University, Claremont, CA, USA
| | - Rahul Kashyap
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
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Gräff I, Pin M, Ehlers P, Seidel M, Hossfeld B, Dietz-Wittstock M, Rossi R, Gries A, Ramshorn-Zimmer A, Reifferscheid F, Reinhold T, Band H, Kuhl KH, König MK, Kasberger J, Löb R, Krings R, Schäfer S, Wienen IM, Strametz R, Wedler K, Mach C, Werner D, Schacher S. Empfehlungen zum strukturierten Übergabeprozess in der zentralen Notaufnahme. Notf Rett Med 2022. [DOI: 10.1007/s10049-020-00810-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kenaga H, Markova T, Stansfield RB, McCready T, Kumar S. Using a Direct Observation Tool (TOC-CEX) to Standardize Transitions of Care by Residents at a Community Hospital. Ochsner J 2021; 21:381-386. [PMID: 34984053 PMCID: PMC8675625 DOI: 10.31486/toj.20.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: High-quality transitions of care are crucial for patient safety in hospitals, yet few undergraduate curricula include transition-of-care training. In 2012, the Wayne State University Office of Graduate Medical Education (WSUGME) required its residency programs to use the SAIF-IR mnemonic (summary, active issues, if-then contingency planning, follow-up activities, interactive questioning, readback) to ensure accurate and uniform handoffs. Subsequent program evaluations indicated that resident awareness and adoption of the mnemonic at our primary clinical site, Ascension Providence Rochester Hospital (APRH), could be improved. According to our institution's 2016 Clinical Learning Environment Review (CLER), 88% of residents reported following a standardized transition of care handoff, and 53% reported that faculty rarely supervised their handoffs. A 2016 WSUGME internal survey also revealed low rates of awareness (7% to 10%) of the mandated mnemonic. WSUGME then created a direct observation tool, the Transitions of Care-Clinical Evaluation Exercise (TOC-CEX), for faculty to monitor resident skill in using the mnemonic and thus standardize transitions of care as a practice habit at APRH. Methods: Since 2014, WSUGME had relied on 2 methods for training residents in the required handoff mnemonic: (1) introduction to the SAIF-IR mnemonic during the WSUGME orientation for all interns and (2) simulations during an objective simulated handoff evaluation activity for all postgraduate year (PGY) 1s and PGY 2s. In 2017, WSUGME innovated a direct observation tool, the TOC-CEX, for adoption by faculty at APRH to assess resident knowledge of and monitor their skill in using the SAIF-IR mnemonic in 3 primary care programs. The total number of possible participants was 138, and the actual number of individuals in the sample was 95. A majority (86%) of the observations during the study period were of PGY 1 residents, and thus the analysis reflects the ratings of 99% of all interns but only 69% of all possible residents. Results: WSUGME found that faculty use of a direct observation instrument in the clinical learning environment during 2017-2019 increased awareness and adoption of the SAIF-IR mnemonic among residents. Using a z-test of equal proportions on resident responses on an internal WSUGME survey, we found a significant rise in the percentage reporting yes to the question "Does your program have a mechanism for monitoring handoffs?" (χ2 [3]=23.6, P<0.0001) and in the percentage identifying SAIF-IR in response to the question "Does your program endorse a specific mnemonic for organizing the contents of a verbal handoff?" (χ2 [3]=45.0, P<0.0001). The increase from 2016 to 2017 is the result of the implementation of the TOC-CEX in the interim (question 1: χ2 [1]=12.4, P<0.0005; question 2: χ2 [1]=10.1, P<0.0025). Conclusion: Our research found that use of the TOC-CEX to monitor resident handoffs resulted in improved awareness and adoption of the SAIF-IR mnemonic in the clinical learning environment. Program leadership reported that the practice was both feasible and well accepted by residents, faculty, and the APRH chief medical officer as the TOC-CEX became a customary component of APRH organizational culture and was perceived as central to quality patient care.
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Affiliation(s)
- Heidi Kenaga
- Wayne State University School of Medicine Office of Graduate Medical Education, Detroit, MI
| | | | - R. Brent Stansfield
- Wayne State University School of Medicine Office of Graduate Medical Education, Detroit, MI
| | - Tess McCready
- Wayne State University School of Medicine, Detroit, MI
- Transitional Year and Family Medicine Residency Programs, Ascension Providence Rochester Hospital, Rochester, MI
| | - Sarwan Kumar
- Wayne State University School of Medicine, Detroit, MI
- Internal Medicine Residency Program, Ascension Providence Rochester Hospital, Rochester, MI
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Sun LW, Stahulak AL, Costakos DM. Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020. [DOI: 10.1055/s-0040-1718566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented.
Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure.
Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift.
Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.
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Affiliation(s)
- Lynn W. Sun
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrea L. Stahulak
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deborah M. Costakos
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Puzio TJ, Murphy PB, Virtanen P, Harvin JA, Hartwell JL. Handover Practices in Trauma and Acute Care Surgery: A Multicenter Survey Study. J Surg Res 2020; 254:191-196. [PMID: 32450420 DOI: 10.1016/j.jss.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/29/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The handover period has been identified as a particularly vulnerable period for communication breakdown leading to patient safety events. Clear and concise handover is especially critical in high-acuity care settings such as trauma, emergency general surgery, and surgical critical care. There is no consensus for the most effective and efficient means of evaluating or performing handover in this population. We aimed to characterize the current handover practices and perceptions in trauma and acute care surgery. METHODS A survey was sent to 2265 members of the Eastern Association for the Surgery of Trauma via email regarding handoff practices at their institution. Respondents were queried regarding their practice setting, average census, level of trauma center, and patients (trauma, emergency general surgery, and/or intensive care). Data regarding handover practices were gathered including frequency of handover, attendees, duration, timing, and formality. Finally, perceptions of handover including provider satisfaction, desire for improvement, and effectiveness were collected. RESULTS Three hundred eighty surveys (17.1%) were completed. The majority (73.4%) of respondents practiced at level 1 trauma centers (58.9%) and were trauma/emergency general surgeons (86.5%). Thirty-five percent of respondents reported a formalized handover and 52% used a standardized tool for handover. Only 18% of respondents had ever received formal training, but most (51.6%) thought this training would be helpful. Eighty-one percent of all providers felt handover was essential for patient care, and 77% felt it prevented harm. Seventy-two percent thought their handover practice needed improvement, and this was more common as the average patient census increased. The most common suggestions for improvement were shorter and more concise handover (41.6%), different handover medium (24.5%), and adding verbal communication (13.9%). CONCLUSION Trauma and emergency general surgeons perceive handover as essential for patient care and the majority desire improvement of their current handover practices. Methods identified to improve the handover process include standardization, simplification, and verbal interaction, which allows for shared understanding. Formal education and best practice guidelines should be developed.
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Affiliation(s)
- Thaddeus J Puzio
- Department of Acute Care Surgery, The University of Texas Medical Center at Houston.
| | - Patrick B Murphy
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Piiamaria Virtanen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - John A Harvin
- Department of Acute Care Surgery, The University of Texas Medical Center at Houston
| | - Jennifer L Hartwell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Papademetriou M, Perrault G, Pitman M, Gillespie C, Zabar S, Weinshel E, Williams R. Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones. World J Gastroenterol 2020; 26:1221-1230. [PMID: 32231425 PMCID: PMC7093308 DOI: 10.3748/wjg.v26.i11.1221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND System based practice (SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless, structured assessment is required for training programs. We hypothesized that objective structured clinical examination (OSCE) would be an effective tool for assessment of SBP.
AIM To develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.
METHODS For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twenty-six first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.
RESULTS Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22 (SBP1), 4.34 (SBP2), 3.35 (SBP3), and 6.42 (SBP4) out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training, and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was “very useful.” One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.
CONCLUSION OSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP.
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Affiliation(s)
- Marianna Papademetriou
- Division of Gastroenterology, Georgetown University Medical Center, Washington, DC 20007, United States
- Division of Gastroenterology, Washington DC VA Medical Center, Washington, DC 20422, United States
| | - Gabriel Perrault
- Department of Medicine, New York University Medical Center, New York, NY 10016, United States
| | - Max Pitman
- Division of Gastroenterology, New York University Medical Center, New York, NY 10016, United States
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, NY 10016, United States
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY 10016, United States
| | - Elizabeth Weinshel
- Department of Gastroenterology, VA New York Harbor Healthcare System, New York, NY 10010, United States
| | - Renee Williams
- Division of Gastroenterology, New York University Medical Center, New York, NY 10016, United States
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Gee SW, Holt PL, Stoner MJ. Safe Interfacility Transport of Pediatric Patients: Medical Control Training, an Interdisciplinary Approach. Air Med J 2019; 37:120-123. [PMID: 29478576 DOI: 10.1016/j.amj.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal. We sought to close this curriculum gap by developing a MCP training program immersing emergency medicine (EM) and critical care (CC) fellows together with TT members to manage a simulated patient. METHODS Pilot curriculum from 2014-2016 involving 1st year fellows. A case is presented initially with a referral call. By phone the fellow is to communicate with and guide the TT, who is in a separate room managing the "sick" patient using high-fidelity simulation. Each MCP and TT communication is evaluated by faculty and peers. An immediate debriefing session provided formative feedback. RESULTS 11 fellows participated and 10 completed a post-simulation survey (91%). The fellows and TT members rated the curriculum as "highly important" and positively viewed the interprofessional collaboration. Respondents were neutral when asked if communication skills improved. CONCLUSION The MCP training curriculum was viewed favorably and participants reported that this formalized training is needed.
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Affiliation(s)
- Samantha W Gee
- The Ohio State University, Section of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
| | - Philip L Holt
- Nationwide Children's Critical Care Transport Team, Columbus, OH
| | - Michael J Stoner
- Section of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
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Gordon M, Grafton-Clarke C, Hill E. Teaching handover in undergraduate education: an evidence-based multi-disciplinary approach. MEDEDPUBLISH 2019; 8:100. [PMID: 38089334 PMCID: PMC10711954 DOI: 10.15694/mep.2019.000100.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Poor standards of handover threaten patient safety and continuity of care, contributing significantly to morbidity and mortality. Handover practices has risen to the forefront of the patient safety agenda, with a call to develop and implement undergraduate handover modules into undergraduate healthcare education. Recent systematic reviews demonstrate a common failure of educational interventions to demonstrate a theoretical and pedagogical framework underpinning the delivery of education and method of assessment. The authors developed and piloted a multi-disciplinary evidence-based undergraduate handover training program to health care students studying at a UK university. The intervention was designed based on underpinning educational theories. It has been developed in a manner that supports dissemination and replication, with a model that is cost effective. The intervention was designed to assess learner reaction, attitudes and confidence, and knowledge and skills. This was achieved through a pre- and post-intervention attitude questionnaire, and an externally validated pre- and post-intervention knowledge assessment. 46 undergraduate students participated, with a statistically significant increase in self-reported attitudes (p < 0.001) and knowledge (p < 0.001) following the handover intervention. Students participated from the disciplines of medicine, adult nursing, pharmacy, mental health nursing, paramedic practice and operating department practioners. This intervention serves as a significant resource for those looking to develop local interventions and stands as a truly multi-disciplinary approach to handover education, mirroring the clinical reality. The introduction of this handover intervention immediately improves the attitudes, knowledge and skills of undergraduate healthcare students. Future work should sample beyond the selected 6 professions, investigating the transference of outcomes to the workplace, as well as the impact on patient safety.
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Beament T, Ewens B, Wilcox S, Reid G. A collaborative approach to the implementation of a structured clinical handover tool (iSoBAR), within a hospital setting in metropolitan Western Australian: A mixed methods study. Nurse Educ Pract 2018; 33:107-113. [DOI: 10.1016/j.nepr.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 04/20/2018] [Accepted: 08/26/2018] [Indexed: 11/16/2022]
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Kim JH, Hur MH, Kim HY. The efficacy of simulation-based and peer-learning handover training for new graduate nurses. NURSE EDUCATION TODAY 2018; 69:14-19. [PMID: 30007141 DOI: 10.1016/j.nedt.2018.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/16/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nursing handovers are a crucial nursing practice for patient safety and continuity of nursing care. As a strategy to improve nursing handovers, it has been suggested that new graduate nurses receive training in how to conduct handovers. OBJECTIVES The purpose of this study was to examine the effects of simulation-based handover training and peer-learning handover training on clinical competence regarding handovers and clinical judgment among new graduate nurses. DESIGN Quasi-experimental research using a nonequivalent control group post-test design. PARTICIPANTS A convenience sample of 55 new graduate nurses with no clinical experience who expected to work at a university hospital were selected. METHODS We measured participants' clinical competence regarding handovers and clinical judgment immediately after completing a training program and after 1 month of working at a hospital to examine the immediate and latent effects of simulation-based and peer-learning handover training, respectively. A researcher-developed clinical competence instrument regarding handovers and a clinical judgment instrument based on the Lasater Clinical Judgment Rubric were used. To identify differences in the effects of simulation-based and peer-learning handover training, we analyzed the data using the independent t-test and paired t-test. When evaluating the latent effects, the participants wrote self-reflection reports. RESULTS There were no significant differences in the immediate effects of the simulation-based training and the peer-learning training. In contrast, in the evaluation of the latent effects, new graduate nurses who received simulation-based training showed significantly higher clinical competence regarding handovers (p = .020) and clinical judgment (p = .033) than their counterparts who received peer-learning training. In the self-reflection reports, 19 participants stated that they had gained more confidence with handovers. CONCLUSION We suggest that simulation-based handover training contributes more to the improvement of new graduate nurses' clinical competence regarding handovers and clinical judgment than peer-learning training.
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Affiliation(s)
- Jung Hee Kim
- Department of Nursing, Shinsung University, 1 Daehak-ro, Jeongmi-myeon, Dangjin-si, Chungcheongnam-do, 31801, Republic of Korea
| | - Myung-Haeng Hur
- College of Nursing, Eulji University, 77 Gyeryong-ro, 771 beon-gil, Jung-gu, Daejeon 34824, Republic of Korea.
| | - Hyun-Young Kim
- Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju-si 55069, Republic of Korea.
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Thaeter L, Schröder H, Henze L, Butte J, Henn P, Rossaint R, Sopka S. Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany. BMJ Open 2018; 8:e021202. [PMID: 30209154 PMCID: PMC6144335 DOI: 10.1136/bmjopen-2017-021202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN A controlled educational research study. SETTING The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. PARTICIPANTS A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). OUTCOME MEASURES Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. RESULTS Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. CONCLUSION We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.
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Affiliation(s)
- Laura Thaeter
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Hanna Schröder
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lina Henze
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jennifer Butte
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Patrick Henn
- School of Medicine, University College Cork, Cork, Ireland
| | - Rolf Rossaint
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saša Sopka
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
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A Standardized Handoff Simulation Promotes Recovery From Auditory Distractions in Resident Physicians. Simul Healthc 2018; 13:233-238. [PMID: 29727347 DOI: 10.1097/sih.0000000000000322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the increasing use of training simulations to teach and assess resident handoffs, simulations that approximate realistic hospital conditions with distractions are lacking. This study explores the effects of a novel simulation-based training intervention on resident handoff performance in the face of prevalent hospital interruptions. METHODS After a preliminary educational module, entering postgraduate year 1 residents (interns) completed one of the following three handoff simulations: (1) no interruption, (2) hospital noise, or (3) noise and pager interruptions. Trained receivers rated interns using an evidence-based Handoff Behaviors Checklist and a previously validated Handoff Mini-Clinical Examination Exercise instrument. RESULTS Of 127 eligible interns, 125 (98.4%) completed an online preparatory module and a handoff simulation. Interns receiving auditory interruptions were less likely to be heard adequately (48.8% noise and 71.8% noise + pager vs. 100.0% uninterrupted, P < 0.001) and scored lower on establishing appropriate handoff settings (5.7 ± 2.3 noise and 6.2 ± 1.8 noise + pager vs. 8.0 ± 0.8 uninterrupted, P < 0.001). Interns receiving noise only shared a written sign-out document more effectively (71.1% vs. 30.2% uninterrupted and 43.6% noise + pager, P < 0.001). There were no differences in averaged performance metrics on the Handoff Behaviors Checklist. DISCUSSION While common hospital interruptions created nonideal circumstances for the handoff, interns receiving interruptions were rated similarly and recovered effectively. However, interns exposed to noise only used the written sign-out form more actively. Our findings suggest that this intervention was successful in promoting handoff proficiency despite exposure to common but significant hospital interruptions.
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Sirgo Rodríguez G, Chico Fernández M, Gordo Vidal F, García Arias M, Holanda Peña MS, Azcarate Ayerdi B, Bisbal Andrés E, Ferrándiz Sellés A, Lorente García PJ, García García M, Merino de Cos P, Allegue Gallego JM, García de Lorenzo Y Mateos A, Trenado Álvarez J, Rebollo Gómez P, Martín Delgado MC. Handover in Intensive Care. Med Intensiva 2018; 42:168-179. [PMID: 29426704 DOI: 10.1016/j.medin.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 01/12/2023]
Abstract
Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.
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Affiliation(s)
- G Sirgo Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, España
| | - M Chico Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Azcarate Ayerdi
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - A Ferrándiz Sellés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - P J Lorente García
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - M García García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J M Allegue Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, España
| | - P Rebollo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid.
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Hill E, Cartabuke RH, Mehta N, Colbert C, Nowacki AS, Calabrese C, Mehdi A, Garber A, Mohmand M, Sinokrot O, Pile J. Resident-Led Handoffs Training for Interns: Online Versus Live Instruction with Subsequent Skills Assessment. Am J Med 2017; 130:1225-1230.e6. [PMID: 28684343 DOI: 10.1016/j.amjmed.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth Hill
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio.
| | | | - Neil Mehta
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Colleen Colbert
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Ali Mehdi
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio
| | - Ari Garber
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio
| | - Mohammad Mohmand
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio
| | - Odai Sinokrot
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio
| | - James Pile
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
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Murphy HJ, Karpinski AC, Messer A, Gallois J, Mims M, Farge A, Hernandez L, Steinhardt M, Sandlin C. Resident Workshop Standardizes Patient Handoff and Improves Quality, Confidence, and Knowledge. South Med J 2017; 110:571-577. [PMID: 28863221 DOI: 10.14423/smj.0000000000000698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Residency programs are required to instruct residents in handoff; however, a handoff curriculum endorsed by the Accreditation Council for Graduate Medical Education does not exist. Although curricula are available, we preferred to use a curriculum that could be taught quickly, was easy to implement, and used a mnemonic that resembled current practices at our institution. We designed and implemented a novel handoff educational workshop intended to improve resident confidence and performance. METHODS In this observational study, pediatric residents across postgraduate training years during winter 2014-spring 2015 participated in two study segments: a handoff workshop with questionnaires and handoff observations. Co-investigators developed and led an interactive workshop for residents that emphasized a standardized approach using the SIGNOUT mnemonic (see text for definition). The effect of workshop participation on handoff abilities was evaluated using a validated, handoff evaluation tool administered before and after the workshop. Qualitative feedback was obtained from residents using pre- and postworkshop surveys. RESULTS Forty-three residents participated in the workshop; 41 residents completed handoff observations. Improvements were noted in clinical judgment (P = 0.02) and organization/communication (P = 0.005). Pre- and postworkshop surveys demonstrated self-perceived increases in confidence, comfort, and knowledge (P < 0.001). CONCLUSIONS Improvements in handoffs, particularly in clinical judgment and organization/communication domains, suggest that a more standardized handoff approach is beneficial, especially for postgraduate year 1 residents. The novel, interactive workshop we developed can be taught quickly, is easy to implement, is appropriate for all resident training levels, and improves resident confidence and skill. This workshop can be implemented by training programs across all disciplines, possibly leading to improved patient safety.
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Affiliation(s)
- Heidi J Murphy
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Aryn C Karpinski
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Amanda Messer
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Julie Gallois
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Michelle Mims
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Ashley Farge
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Lauren Hernandez
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Michelle Steinhardt
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
| | - Chelsey Sandlin
- From the Department of Pediatrics, Louisiana State University Health Science Center, New Orleans
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Kalet A, Zabar S, Szyld D, Yavner SD, Song H, Nick MW, Ng G, Pusic MV, Denicola C, Blum C, Eliasz KL, Nicholson J, Riles TS. A simulated "Night-onCall" to assess and address the readiness-for-internship of transitioning medical students. Adv Simul (Lond) 2017; 2:13. [PMID: 29450014 PMCID: PMC5806245 DOI: 10.1186/s41077-017-0046-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic "night on call" experience for near graduating students and build measurements of students' readiness for this transition framed by the Association of American Medical College's Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.
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Affiliation(s)
- Adina Kalet
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Sondra Zabar
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Demian Szyld
- Department of Emergency Medicine, Center for Medical Simulation, Institute for Medical Simulation, Harvard Medical School, Boston, MA USA
| | - Steven D Yavner
- Department of Journalism, Central Connecticut State University, New Britain, CT USA
| | - Hyuksoon Song
- Department of Education, Georgian Court University, Lakewood, NJ USA
| | - Michael W Nick
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Grace Ng
- New York Simulation Center for the Health Sciences, New York, New York USA
| | - Martin V Pusic
- Department of Emergency Medicine, NYU School of Medicine, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
| | - Christine Denicola
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Cary Blum
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
| | - Kinga L Eliasz
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Joey Nicholson
- Health Science Library, NYU School of Medicine, New York, New York USA
| | - Thomas S Riles
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
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Davis R, Davis J, Berg K, Berg D, Morgan CJ, Russo S, Riesenberg LA. Patient Handoff Education: Are Medical Schools Catching Up? Am J Med Qual 2017; 33:140-146. [PMID: 28728430 DOI: 10.1177/1062860617719128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communication errors during shift-to-shift handoffs are a leading cause of preventable adverse events. Nevertheless, handoff skills are variably taught at medical schools. The authors administered questionnaires on handoffs to interns during orientation. Questions focused on medical school handoff education, experiences, and perceptions. The majority (546/718) reported having some form of education on handoffs during medical school, with 48% indicating this was 1 hour or less. Most respondents (98%) reported that they believe patients experience adverse events because of inadequate handoffs, and more than one third had witnessed a patient safety issue. Results show that medical school graduates are not receiving adequate handoff training. Yet graduates are expected to conduct safe patient handoffs at the start of residency. Given that ineffective handoffs pose a significant patient safety risk, medical school graduates should have a baseline competency in handoff skills. This will require medical schools to develop, implement, and study handoff education.
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Affiliation(s)
- Robyn Davis
- 1 The University of Alabama at Birmingham, AL
| | - Joshua Davis
- 2 Pennsylvania State College of Medicine, Hershey, PA
| | - Katherine Berg
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Dale Berg
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | - Stefani Russo
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Alphonso A, Pathy S, Bruno C, Boeras C, Emerson B, Crabtree J, Johnston L, Desai V, Auerbach M. Shoulder Dystocia and Neonatal Resuscitation: An Integrated Obstetrics and Neonatology Simulation Case for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10594. [PMID: 30800796 PMCID: PMC6338204 DOI: 10.15766/mep_2374-8265.10594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/18/2017] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The new model in medical education of longitudinal clinical clerkships can be complemented by high-technology simulation, which provides a safe space for learners to consolidate clinical knowledge and practice decision-making skills, teamwork, and communication. We developed an interdisciplinary training intervention including a simulation case and structured debriefing to link clinical content between pediatrics and obstetrics at a major academic medical center. METHODS In this case, a 38-year-old female at 38 weeks gestation presents with onset of labor complicated by shoulder dystocia. After the appropriate maneuvers, a depressed neonate is delivered and requires resuscitation. Major equipment needed includes a high- or low-technology birthing mannequin and an infant mannequin. RESULTS Fifty-four third-year medical students participated in this simulation-based intervention at the completion of their integrated pediatrics and obstetrics clerkship. Ninety-one percent of students agreed that the shoulder dystocia simulation was designed appropriately for their learning level and enhanced their ability to handle a risky delivery. Ninety-four percent agreed that the neonatal resuscitation simulation was designed appropriately for their learning level, and 89% reported an enhanced ability to handle a similar situation in the clinic following the intervention. The average overall ratings were 4.24 (SD = 0.61) and 4.06 (SD = 0.89) on a 5-point scale (1 = poor, 5 = excellent) for the obstetrics and pediatrics simulations, respectively. DISCUSSION The integrated obstetrics and pediatrics scenario is feasible to run and clinically accurate. Two distinct areas of medicine in the third-year curriculum are logically incorporated into one cohesive simulation-based training intervention that students found positive and realistic.
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Affiliation(s)
| | - Shefali Pathy
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Christie Bruno
- Assistant Professor, Pediatrics (Neonatology), Yale School of Medicine
| | - Crina Boeras
- Clinical Assistant Provider, Bridgeport Hospital
- Clinical Instructor, Department Of Obstetrics And Gynecology, Yale School of Medicine
| | - Beth Emerson
- Assistant Professor, Pediatric Emergency Medicine, Yale School of Medicine
| | - Janice Crabtree
- Manager of Medical Education, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Lindsay Johnston
- Associate Professor of Pediatrics (Neonatology), Yale School of Medicine
| | - Vrunda Desai
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Marc Auerbach
- Associate Professor, Pediatrics and Emergency Medicine, Yale School of Medicine
- Director of Pediatric Simulation, Yale Center For Medical Simulation
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Davis J, Roach C, Elliott C, Mardis M, Justice EM, Riesenberg LA. Feedback and Assessment Tools for Handoffs: A Systematic Review. J Grad Med Educ 2017; 9:18-32. [PMID: 28261391 PMCID: PMC5319625 DOI: 10.4300/jgme-d-16-00168.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs. OBJECTIVE We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools. METHODS The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system. RESULTS A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters. CONCLUSIONS A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.
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Affiliation(s)
| | | | | | | | | | - Lee Ann Riesenberg
- Corresponding author: Lee Ann Riesenberg, PhD, RN, CMQ, University of Alabama at Birmingham, Department of Anesthesiology and Perioperative Medicine, JT 909, 619 South 19th Street, Birmingham, AL 35249-6180, 205.975.3729, fax 205.975.3552,
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Lo HY, Mullan PC, Lye C, Gordon M, Patel B, Vachani J. A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu212920.w5661. [PMID: 28074133 PMCID: PMC5174810 DOI: 10.1136/bmjquality.u212920.w5661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/30/2016] [Indexed: 12/16/2022]
Abstract
Handoffs represent a critical transition point in patient care that play a key role in patient safety. Our quality improvement project was a descriptive observational study aimed at standardizing pediatric hospitalist handoffs via implementation of a handoff checklist, with the goal of improving handoff quality and physician satisfaction within six months. The handoff checklist was quickly adapted by hospitalists, with median compliance rate of 83% during the study. Handoff quality was assessed by trained observers using the validated Handoff Clinical Evaluation Exercise (CEX) tool at multiple time periods pre- and post-implementation (at 2, 6, 12, and 24 months). Handoff quality improved during our study, with a significant decrease in the percentage of "unsatisfactory" handoffs from 9% to 0% (p-value 0.004), an effect which was sustained after initial project completion. The cumulative time required for verbal handoffs for different attending physicians paralleled patient census. However, our project identified wasted down time between individual physician handoffs, and an intervention to change shift times led to a decrease in the average total handoff process time from 86 minutes to 60 minutes, p-value <0.001. An average of 7.4 patient care items was identified during handoffs. A physician perception survey revealed improved situational awareness, efficiency, patient safety, and physician satisfaction as a result of our handoff improvement project. In conclusion, implementation of a checklist and standardized handoff process for pediatric hospitalists improved handoff efficiency and quality, as well as physician satisfaction.
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Higgins Joyce A. Team-Based Simulation for Medical Student Handoff Education. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10486. [PMID: 30984828 PMCID: PMC6440419 DOI: 10.15766/mep_2374-8265.10486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/03/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Good handoffs require teamwork, clear communication, a cognitively safe environment, and a good understanding of the patient's medical needs. Complex tertiary care training institutions require multiple handoffs over a patient's time in the hospital. Medical students need better handoff education. We designed a handoff training exercise using a simulated patient care environment for students to practice and observe multiple handoffs over time. METHODS An initial large-group didactic session provides direct instruction on handoffs. In small groups, students are subsequently assigned roles as individual physicians in a chain of providers during a simulated patient hospitalization over several days, with an additional student as an observer. Blinded to any prior discussion, student physicians sequentially give and receive handoffs about the patient from a previous physician as their simulated hospital course evolves. The observer shares his or her insights, and a large-group structured debriefing exercise follows. RESULTS In both 2015 and 2016, we implemented this session with a cohort of 30 fourth-year medical students. Most recently we implemented this with chief residents, and a group of 20 third-year pediatric clerkship students. We reviewed a selection of the discussion guides and found reporters/ observers noted that participants stated the primary problem 95% of the time (19 of 20 handoffs), the patient acuity 90% of the time (18 of 20 handoffs), and a clear contingency plan 85% of the time (17 of 20 handoffs). DISCUSSION We found students initially to be preoccupied with making correct clinical decisions instead of giving effective handoffs, and consequently we clarified details and adjusted clinical information to be more transparent. Results suggest the session achieves our goals of using a structured handoff method to communicate higher-level information and debrief effectively with peers. We envision this activity to be applicable to teaching handoffs to residents, nurses, and other health care professionals, as well as possibly in diverse clinical environments or in collaboration with outpatient providers.
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Affiliation(s)
- Alanna Higgins Joyce
- Assistant Professor, Department of Pediatrics, Northwestern University The Feinberg School of Medicine
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Buckley S, Ambrose L, Anderson E, Coleman JJ, Hensman M, Hirsch C, Hodson J, Morley D, Pittaway S, Stewart J. Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review: BEME Guide No. 41. MEDICAL TEACHER 2016; 38:966-980. [PMID: 27626840 DOI: 10.1080/0142159x.2016.1215412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Calls for the inclusion of standardized protocols for information exchange into pre-registration health professions curricula have accompanied their introduction into clinical practice. In order to help clinical educators respond to these calls, we have reviewed educational interventions for pre-registration students that incorporate one or more of these ?tools for structured communication?. METHODS Searches of 10 databases (1990?2014) were supplemented by hand searches and by citation searches (to January 2015). Studies evaluating an intervention for pre-registration students of any clinical profession and incorporating at least one tool were included. Quality of included studies was assessed using a checklist of 11 indicators and a narrative synthesis of findings undertaken. RESULTS Fifty studies met our inclusion criteria. Of these, 21 evaluated the specific effect of a tool on educational outcomes, and 27 met seven or more quality indicators. CONCLUSIONS Pre-registration students, particularly those in the US, are learning to use tools for structured communication either in specific sessions or integrated into more extensive courses or programmes; mostly 'Situation Background Assessment Recommendation' and its variants. There is some evidence that learning to use a tool can improve the clarity and comprehensiveness of student communication, their perceived self-confidence and their sense of preparedness for clinical practice. There is, as yet, little evidence for the transfer of these skills to the clinical setting or for any influence of teaching approach on learning outcomes. Educators will need to consider the positioning of such learning with other skills such as clinical reasoning and decision-making.
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Affiliation(s)
- Sharon Buckley
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Lucy Ambrose
- b The Tutbury Practice, Burton-on-Trent, (Formerly Keele University, UK)
| | - Elizabeth Anderson
- c Department of Medical and Social Care Education , University of Leicester , Leicester , UK
| | - Jamie J Coleman
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Marianne Hensman
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Christine Hirsch
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - James Hodson
- d Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - David Morley
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Sarah Pittaway
- a College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jonathan Stewart
- e Retired (formerly Heart of England NHS Foundation Trust, West Midlands, UK)
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Walia J, Qayumi Z, Khawar N, Dygulska B, Bialik I, Salafia C, Narula P. Physician Transition of Care: Benefits of I-PASS and an Electronic Handoff System in a Community Pediatric Residency Program. Acad Pediatr 2016; 16:519-23. [PMID: 27090859 DOI: 10.1016/j.acap.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Miscommunication is a leading cause of adverse events in hospitals. Optimizing the handoff process improves communication and patient safety. We sought to assess how the components of I-PASS (a mnemonic for illness severity, patient summary, action list, situational awareness with contingency planning, and synthesis by the receiver), a standardized handoff bundle, improved the quality of handoffs in a pediatric residency program based in a community hospital. METHODS Pediatric residents in a university-affiliated community teaching hospital were observed on the pediatric inpatient floor and in the newborn nursery. One hundred resident handoffs per setting were analyzed in 3 phases, with a total of 600 handoffs assessed. Phase 1 comprised preintervention handoffs before I-PASS; phase 2, initiating I-PASS mnemonic and educational session; and phase 3, implementing a handoff tool, electronic physician handoff (EPH), into the electronic medical record. One attending physician at each setting assessed the handoff process using an 11-item survey. A resident satisfaction survey assessed the resident's experience after phase 3. RESULTS Comparing phase 1 with phase 2, there was improved situational awareness with contingency planning (nursery: 12% to 83%, P = .001; floor: 21% to 84%, P = .001). Incidence of tangential conversation decreased in both settings (nursery: 100% to 23%, P = .001; floor: 84% to 11%, P = .001). Comparing phase 2 with phase 3, there was improvement in identification of illness severity (nursery: 62% to 99%, P = .001; floor: 41% to 64%, P = .001) and fewer omissions of important information (nursery: 14% to 0%, P = .001; floor: 33% to 17%, P = .007). A total of 93% of residents found the new EPH system to be beneficial. CONCLUSIONS Specific components of a standardized handoff system, including a mnemonic, an educational intervention, and an EPH, improved the clarity and organization of key information in handoff.
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Gaffney S, Farnan JM, Hirsch K, McGinty M, Arora VM. The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance. J Gen Intern Med 2016; 31:438-41. [PMID: 26831306 PMCID: PMC4803693 DOI: 10.1007/s11606-016-3591-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/11/2015] [Accepted: 01/18/2016] [Indexed: 01/11/2023]
Abstract
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 "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, 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.
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Affiliation(s)
- Sean Gaffney
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jeanne M Farnan
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Kristen Hirsch
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Michael McGinty
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Vineet M Arora
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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Reyes JA, Greenberg L, Amdur R, Gehring J, Lesky LG. Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:163-73. [PMID: 26174046 PMCID: PMC4749641 DOI: 10.1007/s10459-015-9621-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/06/2015] [Indexed: 05/13/2023]
Abstract
Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241.
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Affiliation(s)
- Juan A Reyes
- Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA.
| | - Larrie Greenberg
- The Clinical Learning and Simulation Skills Center, Office of Medical Education, The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA
| | - Richard Amdur
- The George Washington University Medical Faculty Associates Biostatistics Core, Washington, DC, 20037, USA
| | - James Gehring
- Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA
| | - Linda G Lesky
- Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA
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Hern HG, Gallahue FE, Burns BD, Druck J, Jones J, Kessler C, Knapp B, Williams S. Handoff Practices in Emergency Medicine: Are We Making Progress? Acad Emerg Med 2016; 23:197-201. [PMID: 26765246 DOI: 10.1111/acem.12867] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Transitions of care present a risk for communication error and may adversely affect patient care. This study addresses the scope of current handoff practices amongst U.S. emergency medicine (EM) residents. In addition, it evaluates current educational and evaluation practices related to handoffs. Given the ever-increasing emphasis on transitions of care in medicine, we sought to determine if interval changes in resident transition of care education, assessment, and proficiency have occurred. METHODS This was a cross-sectional survey study guided by the Kern model for medical curriculum development. The Council of Residency Directors Listserv provided access to 175 programs. The survey focused on elucidating current practices of handoffs from emergency physicians (EPs) to EPs, including handoff location and duration, use of any assistive tools, and handoff documentation in the emergency department (ED) patient's medical record. Multiple-choice questions were the primary vehicle for the response process. A four-point Likert-type scale was used in questions regarding perceived satisfaction and competency. Respondents were not required to answer all questions. Responses were compared to results from a similar 2011 study for interval changes. RESULTS A total of 127 of 175 programs responded to the survey, making the overall response rate 72.6%. Over half of respondents (72 of 125, 57.6%) indicated that their ED uses a standardized handoff protocol, which is a significant increase from 43.2% in 2011 (p = 0.018). Of the programs that do have a standardized system, a majority (72 of 113, 63.7%) of resident physicians use it regularly. Significant increases were noted in the number of programs offering formal training during orientation (73.2% from 59.2%; p = 0.015), decreases in the number of programs offering no training (2.4% from 10.2%; p = 0.013), and no assessment of proficiency (51.5% from 69.8%; p = 0.006). No significant interval changes were noted in handoffs being documented in the patient's medical record (57.4%), the percentage of computer/electronic signouts, or the level of dissatisfaction with handoff tools (54.1%). Less than two-thirds of respondents (80 of 126, 63.5%) indicated that their residents were "competent" or "extremely competent" in delivering and receiving handoffs. CONCLUSIONS An insufficient level of handoff training is currently mandated or available for EM residents, and their handoff skills appear to be developed mostly informally throughout residency training with varying results. Programs that have created a standardized protocol are not ensuring that the protocol is actually being employed in the clinical arena. Handoff proficiency most often goes unevaluated, although it is improved from 2011.
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Affiliation(s)
- H. Gene Hern
- Department of Emergency Medicine; Alameda Health System - Highland Hospital; Oakland CA
| | - Fiona E. Gallahue
- Division of Emergency Medicine; University of Washington; Seattle WA
| | - Boyd D. Burns
- Department of Emergency Medicine; University of Oklahoma; School of Community Medicine; Tulsa OK
| | - Jeffrey Druck
- Department of Emergency Medicine; University of Colorado; Denver CO
| | - Jonathan Jones
- Department of Emergency Medicine; University of Mississippi; Jackson MS
| | - Chad Kessler
- Department of Emergency Medicine; Veterans Affairs Health System; Chicago IL
| | - Barry Knapp
- Department of Emergency Medicine; Eastern Virginia Medical School; Norfolk VA
| | - Sarah Williams
- Division of Emergency Medicine; Stanford University; Stanford CA
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Stojan J, Mullan P, Fitzgerald J, Lypson M, Christner J, Haftel H, Schiller J. Handover education improves skill and confidence. CLINICAL TEACHER 2015; 13:422-426. [DOI: 10.1111/tct.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jennifer Stojan
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Patricia Mullan
- Department of Medical Education; University of Michigan Medical School; Ann Arbor Michigan USA
| | - James Fitzgerald
- Department of Internal Medicine; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Monica Lypson
- Department of Medical Education; University of Michigan Medical School; Ann Arbor Michigan USA
| | | | - Hilary Haftel
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
| | - Jocelyn Schiller
- Department of Pediatrics; University of Michigan Medical School; Ann Arbor Michigan USA
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Wong BM. Reporting on Patient Safety and Quality Improvement Education: Designing Projects for Optimal Dissemination. J Grad Med Educ 2015; 7:513-6. [PMID: 26692958 PMCID: PMC4675402 DOI: 10.4300/jgme-d-15-00402.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Brian M. Wong
- Corresponding author: Brian M. Wong, MD, FRCPC, University of Toronto, Sunnybrook Health Sciences Centre, Room H466, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada,
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Saleem AM, Paulus JK, Vassiliou MC, Parsons SK. Initial assessment of patient handoff in accredited general surgery residency programs in the United States and Canada: a cross-sectional survey. Can J Surg 2015. [PMID: 26204366 DOI: 10.1503/cjs.016414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Communication errors are considered one of the major causes of sentinel events. Our aim was to assess the process of patient handoff among junior surgical residents and to determine ways in which to improve the handoff process. METHODS We conducted nationwide surveys that included all accredited general surgery residency programs in the United States and Canada. RESULTS Of the 244 American and 17 Canadian accredited surgical residency programs contacted, 65 (27%) and 12 (71%), respectively, participated in the survey. Of the American and Canadian respondents, 66% and 69%, respectively, were from postgraduate year (PGY) 1, and 32% and 29%, respectively, were from PGY 2; 85 (77%) and 50 (96%), respectively, had not received any training about patient handoff before their surgical residency, and 27% and 64%, respectively, reported that the existing handoff system at their institutions did not adequately protect patient safety. Moreover, 29% of American respondents and 37% of Canadian respondents thought that the existing handoffs did not support continuity of patient care. Of the American residents, 67% and 6% reported receiving an incomplete handoff that resulted in minor and major patient harm, respectively. These results mirrored those from Canadian residents (63% minor and 7% major harm). The most frequent factor reported to improve the patient handoff process was standardization of the verbal handoff. CONCLUSION Our survey results indicate that the current patient handoff system contributes to patient harm. More efforts are needed to establish standardized forms of verbal and written handoff to ensure patient safety and continuity of care.
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Affiliation(s)
- Abdulaziz M Saleem
- From the Department of General Surgery, McGill University Health Centre, Montreal, Que. (Saleem, Vassiliou); the Tufts Clinical and Translational Science Institute, Boston, Mass. (Paulus); and the Department of Medicine, Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass. (Parsons)
| | - Jessica K Paulus
- From the Department of General Surgery, McGill University Health Centre, Montreal, Que. (Saleem, Vassiliou); the Tufts Clinical and Translational Science Institute, Boston, Mass. (Paulus); and the Department of Medicine, Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass. (Parsons)
| | - Melina C Vassiliou
- From the Department of General Surgery, McGill University Health Centre, Montreal, Que. (Saleem, Vassiliou); the Tufts Clinical and Translational Science Institute, Boston, Mass. (Paulus); and the Department of Medicine, Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass. (Parsons)
| | - Susan K Parsons
- From the Department of General Surgery, McGill University Health Centre, Montreal, Que. (Saleem, Vassiliou); the Tufts Clinical and Translational Science Institute, Boston, Mass. (Paulus); and the Department of Medicine, Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass. (Parsons)
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McKechnie A. Clinical handover: the importance, problems and educational interventions to improve its practice. Br J Hosp Med (Lond) 2015; 76:353-7. [DOI: 10.12968/hmed.2015.76.6.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew McKechnie
- ST7 Anaesthetist in the Department of Anaesthesia, Kings College Hospital, London SE5 9RS
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Mohorek M, Webb TP. Establishing a conceptual framework for handoffs using communication theory. JOURNAL OF SURGICAL EDUCATION 2015; 72:402-409. [PMID: 25498882 DOI: 10.1016/j.jsurg.2014.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND A significant consequence of the 2003 Accreditation Council for Graduate Medical Education duty hour restrictions has been the dramatic increase in patient care handoffs. Ineffective handoffs have been identified as the third most common cause of medical error. However, research into health care handoffs lacks a unifying foundational structure. We sought to identify a conceptual framework that could be used to critically analyze handoffs. METHODS A scholarly review focusing on communication theory as a possible conceptual framework for handoffs was conducted. A PubMed search of published handoff research was also performed, and the literature was analyzed and matched to the most relevant theory for health care handoff models. RESULTS The Shannon-Weaver Linear Model of Communication was identified as the most appropriate conceptual framework for health care handoffs. The Linear Model describes communication as a linear process. A source encodes a message into a signal, the signal is sent through a channel, and the signal is decoded back into a message at the destination, all in the presence of internal and external noise. The Linear Model identifies 3 separate instances in handoff communication where error occurs: the transmitter (message encoding), channel, and receiver (signal decoding). CONCLUSIONS The Linear Model of Communication is a suitable conceptual framework for handoff research and provides a structured approach for describing handoff variables. We propose the Linear Model should be used as a foundation for further research into interventions to improve health care handoffs.
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Affiliation(s)
- Matthew Mohorek
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Travis P Webb
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Arbuckle MR, Reardon CL, Young JQ. Residency training in handoffs: a survey of program directors in psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:132-138. [PMID: 25026947 DOI: 10.1007/s40596-014-0167-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/12/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate how psychiatry programs are addressing the new Accreditation Council for Graduate Medical Education (ACGME) training requirements regarding transitions in patient care effective July 1, 2011. METHODS An anonymous online survey was distributed to program directors of general psychiatry residencies within the USA. Survey questions pertaining to the 2011 ACGME handoff requirements focused on training modalities, assessment of competence, and oversight of appropriate handoff procedures. In addition, program directors were asked to share specific challenges in implementing the new handoff regulations as well as their view on how the new regulations would impact patient care. RESULTS Of the 177 recipients, 108 completed at least part of the survey (61 % response rate). Only 11.4 % of programs indicated that they did not need to make any changes to their program in order to meet the new guidelines. Approximately a third of survey respondents reported that they did not yet have a formal curriculum in handoffs (32.4 %) and/or did not specifically assess competence at handoffs (30.5 %). Program directors cited the challenge of working with a variety of clinical settings with unique cultures, infrastructure, and policies and procedures and suggested that implementation and ownership of handoff training and assessment should be at the level of the clinical services. Despite these challenges, most program directors agreed that the new ACGME requirements would improve patient care and safety. CONCLUSIONS The high frequency of programs without established handoff curricula or competence evaluations highlights the potential value of published resources and tools to provide standardized training and assessment in handoffs. The results also underscore the importance of developing training and assessment in close collaboration with the clinical services and recognizing the need to tailor handoff communications to address the types of transitions that occur within each clinical setting.
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Affiliation(s)
- Melissa R Arbuckle
- Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA,
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Stojan JN, Schiller JH, Mullan P, Fitzgerald JT, Christner J, Ross PT, Middlemas S, Haftel H, Stansfield RB, Lypson ML. Medical school handoff education improves postgraduate trainee performance and confidence. MEDICAL TEACHER 2015; 37:281-288. [PMID: 25155969 DOI: 10.3109/0142159x.2014.947939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training. METHODS About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p<0.05. RESULTS About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p<0.05); they were also more confident in their handoff abilities (p<0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p<0.05). CONCLUSIONS This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.
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Abstract
INTRODUCTION Handoff communication is an important contributor to safety and quality in the emergency department (ED). Breakdowns in this process may lead to unsafe conditions or adverse events. The purpose of this study was to test the hypothesis that the quality of patient handoffs in the pediatric ED would improve after implementation of a structured handoff method. METHODS In this prospective, observational study, we evaluated the implementation of a structured handoff tool, SOUND, which we developed to standardize the format of handoffs. The tool contains 5 components as follows: Synthesis, Objective Data, Upcoming Tasks, Nursing Input, and Double Check. SOUND was implemented through an online module and provider education. Handoffs were observed before and after implementation of SOUND. Statistical process control was used to measure the effects of the intervention. A successful handoff was defined as one in which 4 of the 5 components were included. As a balancing measure, we calculated mean time per handoff. RESULTS We observed 638 handoffs. The implementation of SOUND significantly increased the percentage of successful handoffs. Statistical process control demonstrated continued improvement over time. This improvement was associated with a modest increase in the mean time per patient discussed (52.9 vs 73.0 seconds, P < 0.01). CONCLUSIONS It is feasible to standardize patient handoffs in the pediatric ED. The implementation of SOUND improved completeness of handoffs with only a modest increase in the mean time spent discussing each patient. Future study is required to determine if SOUND will prove effective in other ED settings.
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Smith CJ, Wadman MC, Harrison J, Beck GL. Assessment of a Brief Handoff Skills Workshop for Incoming Interns: Do past Handoff Experiences Impact Training Outcomes? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2015; 2:JMECD.S28401. [PMID: 35187249 PMCID: PMC8855376 DOI: 10.4137/jmecd.s28401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patient care handoffs are a core professional activity that incoming interns are expected to perform without direct supervision upon starting residency, yet training in medical schools is inconsistent. OBJECTIVE To implement a brief handoff communication workshop for incoming interns and determine whether learner-level determinants were associated with differences in training outcomes. METHODS We conducted a one-hour interactive handoff skills workshop for all incoming interns at a Midwestern academic medical center. We performed paired pre/post-intervention assessments of participants' attitudes and ability to perform representative handoff skills. The results were analyzed in aggregate and based upon participants' prior handoff experiences using Wilcoxon signed-rank test. RESULTS Ninety-nine of 108 interns (91.7%) completed both pre- and post-surveys. There was significant improvement in all 10 attitude-based questions (P ≤ 0.014 for all) and on the skills assessment (1.07 vs 2.16 on 0-4 point scale, SD 1.25, P ≤ 0.001). Results remained significant regardless of prior training, number of handoffs observed, number of handoffs performed, medical school, or residency discipline. CONCLUSION A brief interactive workshop for incoming interns can improve participants' confidence and performance of basic handoff skills, regardless of previous training or experience.
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Affiliation(s)
- Christopher J. Smith
- Department of Internal Medicine, Division of General Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Michael C. Wadman
- Department of Emergency Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Jeffrey Harrison
- Department of Family Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Gary L. Beck
- Office of Medical Education, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
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Gillis AE, Morris MC, Ridgway PF. Communication skills assessment in the final postgraduate years to established practice: a systematic review. Postgrad Med J 2014; 91:13-21. [DOI: 10.1136/postgradmedj-2014-132772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pediatric residency program handover: before and after the ACGME requirement. Acad Pediatr 2014; 14:610-5. [PMID: 25439159 DOI: 10.1016/j.acap.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 06/03/2014] [Accepted: 06/12/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine what changes occurred in pediatric residency programs with regards to handover education and assessment before and after the Accreditation Council for Graduate Medical Education (ACGME) requirement mandating monitoring safe handover practices in July 2011. METHODS We sent surveys at 2 time periods to all pediatric program directors in the United States, as identified from a list provided by the Association of Pediatric Program Directors. Respondents were asked about their program demographics, whether they had handover curricula, how trainees were taught to perform handovers, and perceived barriers to effective handover. RESULTS Response rates were 58% in both survey years. After the ACGME requirement, only 1 of 3 of programs reported a handover curriculum with goals, objectives, and assessment tools. There was a statistically significant increase in the percentage of those responding that resident handover education primarily occurred by role modeling (66% vs 82%; P < .05). Other learners (visiting residents, medical students) also continued to learn handover skills by role modeling (55% vs 56%; P = NS). Lack of feedback and interruptions were recognized as barriers to successful handover by program directors in both survey years. CONCLUSIONS There is a continued need for handover curricula with didactic and practical components as well as assessment pieces within pediatric residency programs. Barriers to effective handover such as lack of feedback and interruptions continue to be major problems. There is a lack of faculty ownership and interest in learner handover that may affect long-term successes. Because role modeling continues to be the main way in which trainees learn handover, specific attention should be given to teach role-modeling techniques.
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Abstract
OBJECTIVES Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents. METHODS Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient's (a) complexity and (b) illness severity. Scores were compared across provider type. RESULTS Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3-4) versus primary and cross-covering providers (median, 4.0; IQR, 3-4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1-5, versus cross cover, 3.5; IQR, 1-5) or illness severity ratings (night shift, 2.0; IQR, 1-4, versus cross-cover, 3.0; IQR, 1-6) when comparing provider types giving a handoff. CONCLUSIONS We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.
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Arora VM, Berhie S, Horwitz LI, Saathoff M, Staisiunas P, Farnan JM. Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise. J Hosp Med 2014; 9:441-6. [PMID: 24665068 PMCID: PMC4079746 DOI: 10.1002/jhm.2185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education. METHODS Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs. RESULTS Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach α of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6 = high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P < 0.001 trend test). Two-way analysis of variance revealed no evidence of rater bias. CONCLUSIONS Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.
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Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, Illinois; Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Starmer AJ, O'Toole JK, Rosenbluth G, Calaman S, Balmer D, West DC, Bale JF, Yu CE, Noble EL, Tse LL, Srivastava R, Landrigan CP, Sectish TC, Spector ND. Development, implementation, and dissemination of the I-PASS handoff curriculum: A multisite educational intervention to improve patient handoffs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:876-84. [PMID: 24871238 DOI: 10.1097/acm.0000000000000264] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patient handoffs are a key source of communication failures and adverse events in hospitals. Despite Accreditation Council for Graduate Medical Education requirements for residency training programs to provide formal handoff skills training and to monitor handoffs, well-established curricula and validated skills assessment tools are lacking. Developing a handoff curriculum is challenging because of the need for standardized processes and faculty development, cultural resistance to change, and diverse institution- and unit-level factors. In this article, the authors apply a logic model to describe the process they used from June 2010 to February 2014 to develop, implement, and disseminate an innovative, comprehensive handoff curriculum in pediatric residency training programs as a fundamental component of the multicenter Initiative for Innovation in Pediatric Education-Pediatric Research in Inpatient Settings Accelerating Safe Sign-outs (I-PASS) Study. They describe resources, activities, and outputs, and report preliminary learner outcomes using data from resident and faculty evaluations of the I-PASS Handoff Curriculum: 96% of residents and 97% of faculty agreed or strongly agreed that the curriculum promoted acquisition of relevant skills for patient care activities. They also share lessons learned that could be of value to others seeking to adopt a structured handoff curriculum or to develop large-scale curricular innovations that involve redesigning firmly established processes. These lessons include the importance of approaching curricular implementation as a transformational change effort, assembling a diverse team of junior and senior faculty to provide opportunities for mentoring and professional development, and linking the educational intervention with the direct measurement of patient outcomes.
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Affiliation(s)
- Amy J Starmer
- Dr. Starmer is staff physician and lecturer in pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts. She is also volunteer affiliate professor, Department of Pediatrics, Oregon Health and Science University (OHSU) and OHSU Doernbecher Children's Hospital, Portland, Oregon. Dr. O'Toole is assistant professor, Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Dr. Rosenbluth is associate professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California. Dr. Calaman is associate professor, Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania. Dr. Balmer is associate professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Dr. West is professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California. Dr. Bale is professor, Departments of Pediatrics and Neurology, University of Utah School of Medicine, Intermountain Healthcare, and Primary Children's Hospital, Salt Lake City, Utah. Dr. Yu is associate professor, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland. Ms. Noble is I-PASS Study research coordinator, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. Ms. Tse is I-PASS Study research assistant, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. Dr. Srivastava is associate professor, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, and Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah. Dr. Landrigan is as
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Liston BW, Tartaglia KM, Evans D, Walker C, Torre D. Handoff practices in undergraduate medical education. J Gen Intern Med 2014; 29:765-9. [PMID: 24549524 PMCID: PMC4000346 DOI: 10.1007/s11606-014-2806-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 12/20/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Growing data demonstrate that inaccuracies are prevalent in current handoff practices, and that these inaccuracies contribute to medical errors. In response, the Accreditation Council for Graduate Medical Education (ACGME) now requires residency programs to monitor and assess resident competence in handoff communication. Given these changes, undergraduate medical education programs must adapt to these patient safety concerns. OBJECTIVES To obtain up-to-date information regarding educational practices for medical students, the authors conducted a national survey of Clerkship Directors in Internal Medicine (CDIM) members. DESIGN AND PARTICIPANTS In June 2012, CDIM surveyed its institutional members, representing 121 of 143 Departments of Medicine in the U.S. and Canada. The section on handoffs included 12 questions designed to define the handoff education and practices of third year clerkship and fourth year sub-internship students. KEY RESULTS Ninety-nine institutional CDIM members responded (82%). The minority (15%) reported a structured handoff curriculum provided during the internal medicine (IM) core clerkship, and only 37% reported a structured handoff curriculum during the IM sub-internship. Sixty-six percent stated that third year students do not perform handoff activities. However, most respondents (93%) reported that fourth year sub-internship students perform patient handoff activities. Only twenty-six (26%) institutional educators in CDIM believe their current handoff curriculum is adequate. CONCLUSIONS Despite the growing literature linking poor handoffs to adverse events, few medical students are taught this competency during medical school. The common practice of allowing untrained sub-interns to perform handoffs as part of a required clerkship raises safety concerns. Evidence-based education programs are needed for handoff training.
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Affiliation(s)
- Beth W Liston
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
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Chasnovitz R, Dandekar A. Can residents improve patient handover through peer feedback? MEDICAL EDUCATION 2014; 48:534-535. [PMID: 24712953 DOI: 10.1111/medu.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Bates KE, Bird GL, Shea JA, Apkon M, Shaddy RE, Metlay JP. A tool to measure shared clinical understanding following handoffs to help evaluate handoff quality. J Hosp Med 2014; 9:142-7. [PMID: 24482325 PMCID: PMC4049065 DOI: 10.1002/jhm.2147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/09/2013] [Accepted: 12/17/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Information exchanged during handoffs contributes importantly to a team's shared mental model. There is no established instrument to measure shared clinical understanding as a marker of handoff quality. OBJECTIVE To study the reliability, validity, and feasibility of the pediatric cardiology Patient Knowledge Assessment Tool (PKAT), a novel instrument designed to measure shared clinical understanding for pediatric cardiac intensive care unit patients. DESIGN To estimate reliability, 10 providers watched 9 videotaped simulated handoffs and then completed a PKAT for each scenario. To estimate construct validity, we studied 90 handoffs in situ by having 4 providers caring for an individual patient each complete a PKAT following handoff. Construct validity was assessed by testing the effects of provider preparation and patient complexity on agreement levels. SETTING A 24-bed pediatric cardiac intensive care unit in a freestanding children's hospital. RESULTS Video simulation results demonstrated score reliability. Average inter-rater agreement by item ranged from 0.71 to 1.00. During in situ testing, agreement by item ranged from 0.41 to 0.87 (median 0.77). Construct validity for some items was supported by lower agreement rates for patients with increased length of stay and increased complexity. DISCUSSION Results suggest that the PKAT has high inter-rater reliability and can detect differences in understanding between handoff senders and receivers for routine and complex patients. Additionally, the PKAT is feasible for use in a real-time clinical environment. The PKAT or similar instruments could be used to study effects of handoff improvement efforts in inpatient settings.
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Affiliation(s)
- Katherine E Bates
- The Cardiac Center, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Abstract
The Accreditation Council for Graduate Medical Education requires that residency programs teach residents about handoffs and ensure their competence in this communication skill. Development of hand-off curricula for anesthesia residency programs is hindered by the paucity of evidence regarding how to conduct, teach, and evaluate handoffs in the various settings where anesthesia practitioners work. This narrative review draws from literature in anesthesia and other disciplines to provide recommendations for anesthesia resident hand-off curriculum development and evaluation.
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Aboumatar H, Allison RD, Feldman L, Woods K, Thomas P, Wiener C. Focus on Transitions of Care. Am J Med Qual 2013; 29:522-9. [DOI: 10.1177/1062860613507330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kessler C, Shakeel F, Hern HG, Jones JS, Comes J, Kulstad C, Gallahue FA, Burns BD, Knapp BJ, Gang M, Davenport M, Osborne B, Velez LI. A survey of handoff practices in emergency medicine. Am J Med Qual 2013; 29:408-14. [PMID: 24071713 DOI: 10.1177/1062860613503364] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to assess practices in emergency department (ED) handoffs as perceived by emergency medicine (EM) residency program directors and other senior-level faculty and to determine if there are deficits in resident handoff training. This cross-sectional survey study was guided by the Kern model for medical curriculum development. A 12-member Council of Emergency Medicine Residency Directors (CORD) Transitions in Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to the CORD listserv. There were 147 responses to the anonymous survey, which were collected using an online tool. At least 41% of the 158 American College of Graduate Medical Education EM residency programs were represented. More than half (56.6%) of responding EM physicians reported that their ED did not use a standardized handoff. There also exists a dearth of formal handoff training and handoff proficiency assessments for EM residents.
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Affiliation(s)
- Chad Kessler
- Jesse Brown VA Hospital, Chicago, IL University of Illinois-Chicago, IL
| | | | - H Gene Hern
- ACMC-Highland General, Oakland, CA University of California, San Francisco, CA
| | | | - Jim Comes
- UCSF Fresno Medical Education Program, Fresno, CA
| | | | | | | | | | | | - Moira Davenport
- Allegheny General Hospital, Pittsburgh, PA Temple University School of Medicine, Philadelphia, PA
| | - Ben Osborne
- Baystate Medical Center, Springfield, MA Tufts University School of Medicine, Springfield, MA
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Didwania A, Kriss M, Cohen ER, McGaghie WC, Wayne DB. Internal medicine postgraduate training and assessment of patient handoff skills. J Grad Med Educ 2013; 5:394-8. [PMID: 24404301 PMCID: PMC3771167 DOI: 10.4300/jgme-d-12-00203.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/25/2012] [Accepted: 11/20/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Effective communication during patient care transitions is essential for high-quality patient care. OBJECTIVE The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill. METHODS We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence. RESULTS Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation = 0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean = 79%, SD = 4.6) and PGY-2 residents (mean = 82%; SD = 7.6; P = .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance. CONCLUSIONS Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.
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Abstract
BACKGROUND Handoffs among post-graduate year 1 (PGY1) trainees occur with high frequency. Peer assessment of handoff competence would add a new perspective on how well the handoff information helped them to provide optimal patient care. OBJECTIVE The goals of this study were to test the feasibility of the approach of an instrument for peer assessment of handoffs by meeting criteria of being able to use technology to capture evaluations in real time, exhibiting strong psychometric properties, and having high PGY1 satisfaction scores. DESIGN An iPad® application was built for a seven-item handoff instrument. Over a two-month period, post-call PGY1s completed assessments of three co-PGY1s from whom they received handoffs the prior evening. PARTICIPANTS Internal Medicine PGY1s at the University of Pennsylvania. MAIN MEASURES ANOVA was used to explore interperson score differences (validity). Generalizability analyses provided estimates of score precision (reproducibility). PGY1s completed satisfaction surveys about the process. KEY RESULTS Sixty-two PGY1s (100 %) participated in the study. 59 % of the targeted evaluations were completed. The major limitations were network connectivity and inability to find the post-call trainee. PGY1 scores on the single item of "overall competency" ranged from 4 to 9 with a mean of 7.31 (SD 1.09). Generalizability coefficients approached 0.60 for 10 evaluations per PGY1 for a single rotation and 12 evaluations per PGY1 across multiple rotations. The majority of PGY1s believed that they could adequately assess handoff competence and that the peer assessment process was valuable (70 and 77 %, respectively). CONCLUSION Psychometric properties of an instrument for peer assessment of handoffs are encouraging. Obtaining 10 or 12 evaluations per PGY1 allowed for reliable assessment of handoff skills. Peer evaluations of handoffs using mobile technology were feasible, and were well received by PGY1s.
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Arora VM, Eastment MC, Bethea ED, Farnan JM, Friedman ES. Participation and experience of third-year medical students in handoffs: time to sign out? J Gen Intern Med 2013; 28:994-8. [PMID: 23595921 PMCID: PMC3710385 DOI: 10.1007/s11606-012-2297-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although interns are expected to be competent in handoff communication, it is currently unclear what level of exposure, participation, and comfort medical students have with handoffs prior to graduation. OBJECTIVE The aim of this study is to characterize passive and active involvement of third-year medical students in the major components of the handoff process. DESIGN An anonymous voluntary retrospective cross-sectional survey administered in 2010. PARTICIPANTS Rising fourth-year students at two large urban private medical schools. MAIN MEASURES Participation and confidence in active and passive behaviors related to written signout and verbal handoffs during participants' third-year clerkships. KEY RESULTS Seventy percent of students (n = 204) responded. As third-year medical students, they reported frequent participation in handoffs, such as updating a written signout for a previously admitted patient (58 %). Students who reported frequent participation (at least weekly) in handoff tasks were more likely to report being confident in that task (e.g., giving verbal handoff 62 % vs. 19 %, p < 0.001). Students at one site that did not have a handoff policy for medical students reported greater participation, more confidence, and less desire for training. Nearly all students believed they had witnessed an error in written signout (98 %) and almost two-thirds witnessed an error due to verbal handoffs (64 %). CONCLUSIONS During their third year, many medical students are participating in handoffs, although reported rates differ across training environments. Medical schools should consider the appropriate level of competence for medical student participation in handoffs, and implement corresponding curricula and assessment tools to ensure that medical students are able to effectively conduct handoffs.
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Affiliation(s)
- Vineet M Arora
- Pritzker School of Medicine, 5841 S. Maryland Ave, MC 2007 AMB W216, Chicago, IL 60637, USA.
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