Teaching the Essentials of a Patient Handoff in an Intern Curriculum Jacob Peschman, MD

1. Teaching the Essentials of a Patient Handoff in an Intern Curriculum Jacob Peschman, MD Tim Ridolfi, MD Philip Redlich, MD, PhD

2. Background • Communication errors are a significant concern in patient care • According to JCAHO from 2009-Q3 2011, 68.7% of Sentinel Events included “Communication Errors” amongst the root causes1 • Transfers of care (patient handoffs) are an important exercise in communication • 1) Joint Commission on Accreditation of Healthcare Organizations:Sentinel Event Statistics Data - Root Causes by Event Type (2004 – Third Quarter 2011). http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-3Q2011.pdf (accessed March 8, 2012).

3. Background • In 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited resident work hours • Increased patient handoffs by 40% to over 300 per month per intern2 • In 2011 work hours were further reduced3 • “Duty periods of PGY-1 residents must not exceed 16 hours in duration” • These changes to duty hours will likely increase the frequency of and reliance on accurate patient handoffs • 2) “Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out”. AR Vidyarthi, et al. 2006 Jul;1(4):257-66. • 3) The Accreditation Council for Graduate Medical Education: Common Program Requirements Effective Jul 1,2011. http://acgme.org/acWebsite/home/Common_Program_Requirements_07012011.pdf(accessed October 14, 2011).

4. Aims Needs Assessment • Quantify the intern training and experience in patient handoffs obtained in medical school prior starting their residency Training • Determine if handoff training during first session of intern curriculum (Protected Block Curriculum (PBC))4 would enhance this necessary skill set • 4) “A PGY1 curriculum- Meeting a need for changing times”. Weigelt, J.A., Simpson, D.E., Anderson, R.C., Brasel, K.J., and Redlich, P.N. Current Surgery 63:410-417, 2006.

5. Methods • Needs assessment survey completed by interns during PBC prior to their start date of July 1, 2011 • Formal handoff training during first PBC in June. • Session evaluations completed at the end of the first 3-day curriculum • Follow-up survey 3 months later during second PBC session evaluating their handoff experience • Self and peer evaluations of organization, standardization, and comprehensiveness of handoffs • Handoff skill development

6. Population • 14 Interns representing 9 Medical Schools • All earned MD’s from LCME accredited schools • None had prior post graduate training

7. Survey Results • Only 22% (2/9) of Medical Schools represented by our intern class provided handoff training • 6 of 14 interns • All interns reported limited handoff experience as medical students • 64% had given a handoff • 29% had received a handoff • 29% reported feeling unprepared to hand off a patient on July 1st • All reported a desire for handoff training prior to residency

8. Training Session • Formal handoff training during their first PBC • Assigned Reading • “Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the Literature”Riesenberg, et al. Acad Med. 2009 Dec;84(12):1775-87. • Thirty minute didactic session with Chief Resident • Twenty minute group practical exercise • Role play: Two typical post-op scenarios presented as handoffs by two interns • Immediate feedback provided by resident and faculty

9. Session Evaluation • Session evaluated for content and teaching • Didactic Session • Content: 4.8 +/- 0.4 SD (1-5 scale) • Teaching: 3.8 +/- 0.4 SD (1-4 scale) • Practical Exercise • Content: 4.7 +/- 0.5 SD (1-5 scale) • Teaching: 3.5 +/- 0.9 SD (1-4 scale) • Participant comments indicated that handoff training should be continued as part of PBC

10. 3 Month Follow-Up Survey • Evaluations of actual handoffs they had been involved with during routine clinical care • Performed self evaluation and a grouped peer evaluation • Likert-type scale from 1-4 • None = 1 • High = 4 • Evaluated three aspects of handoffs • Organization, Standardization, Comprehensiveness

11. 3 Month Follow-Up Survey

12. 3 Month Follow-Up Survey • Influence on development of handoff skills was credited to: • Other residents: 85% • First PBC sessions: 69% • Trial and Error: 69% • Medical school training: 46% • Formal Training: 67% • No Formal Training: 29%

13. 3 Month Follow-Up Survey • In response to the question: • “Can you think of any specific instance you have been involved in this year where patient care was substandard or not optimal due to a poor handoff?” • 54% responded “YES”

14. Conclusions • Communication errors remain a major issue in the healthcare system • Incoming interns have limited handoff experience despite the responsibility starting July 1st • Medical school handoff training reinforced prior to the start of residency would be beneficial • We recognize the impact of poor handoffs and the need for improvement for better patient care

15. Questions? • Acknowledgements • Dr. Rebecca Anderson • Jo auBuchon • The 2011 MCW Surgery Intern Class