Daniel Relles , Renee Tholey, Christine Feldmeier, Richard Burkhart, Stacey Milan

1. Patient handoff simulation: Does formal training build skills and confidence in transitions of patient care? Daniel Relles, Renee Tholey, Christine Feldmeier, Richard Burkhart, Stacey Milan Thomas Jefferson University, Philadelphia, PA April 24, 2013

2. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

3. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

4. Introduction • Medical Errors: • Communication • Transitions in care • Signout process >2x daily • Content vs Process • Formal training and education focus on content • No training on process, efficiency, or self-management

5. Terminology Nightfloat Signout/Handoff “Running the List” RTL 9 - 5 6 - 6 Can new interns be taught systems and strategies to prioritize and recall important patient updates?

6. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

7. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

8. March 2012 1 2 3 1 2 1 Simulation 2 Assessment 3 Training

9. Team Handoff Simulation • End-of day, team “running the list” • Roles • 6 - 8 Interns (MS4) • 1 Junior resident (faculty) • 1 Senior resident (faculty) • Agenda • Activity overview (5 min) • Review of patients (5 min) • “Run the list” (30 min)

10. Team Handoff Simulation • Task • 1 complex patient • 1 basic patient • “You are the intern, who will • sign out to night float after • we run the list.”

11. Materials • Service List • Complex H&P • Basic H&P

12. Materials: Service List

13. Materials: H&P

14. Materials • Service List • Complex H&P • Basic H&P

15. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

16. Assessment: Urgent Issues

17. Assessment: Urgent Issues

18. Assessment: Routine Issues

19. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

20. Training • SimMan simulations • Formal training

21. Formal Training • ~45 minutes • Best practices from PGY1 & PGY2 • “What’s your system?” • Techniques and strategies for patient management • Help support efficiency, recall and prioritization

22. Formal Training • Coloring systems (black = run the list in black, blue = update the list, red = issues to escalate) • Cross-out/check box/circle • Circle, squares, and underlines • Imaging: 3 boxes (ordered/completed/read) • Separate list: top priorities • Document every nursing page • Consistent spaces • Reduced printing • Create table; generate list of “things to do” per pt • Strategic folding

23. Formal Training

24. Formal Training

25. Formal Training

26. Formal Training

27. Formal Training

28. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

29. Identification of Urgent Issues n=21, p<0.05

30. Identification of Routine Issues n=21, p<0.05

31. Overview • Introduction • Methods • Simulation • Assessment • Training • Results • Conclusion

32. Conclusion • Described a simulation of a team signout and patient handoff that is a useful adjunct to on-the-job training • Improved ability to identify and recall urgent and non-urgent service issues • Helped build confidence in recall and prioritization

33. Contact: daniel.relles@jeffersonhospital.org