Handing Over Patient Care: Is it just the old broken telephone game?
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Transcript of Handing Over Patient Care: Is it just the old broken telephone game?
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Handing Over Patient Care:Is it just the old broken telephone game?
Benjamin Zendejas, MD, MSc
Shahzad M. Ali, MD
Marianne Huebner, PhD
David R. Farley, MD
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Transfer of Patient Care
• Sign-out
• Shift report
• Hand-over
• Handoff
?
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Handoff
“the exchange between health professionals of information about a patient accompanying either a transfer of control over, or of responsibility for, the patient.”
Cohen MD, et. al. Qual Saf Health Care, 2010
The Joint Commission 2008
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The Reality
• Handoff accuracy hinges on communication
• Communication is prone to human error
• Poor quality handoffs:• Adverse events• Near misses• Legal lawsuits
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Communication andTech-Enhanced Handoffs
Face-to-Face
Written
Telephone
Computer
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Study Aims
• Tech-enhanced vs face-to-face handoffs
• Handoff quality measures
• Trainee Preference
• Improvement over time
• Sleep and handoff accuracy
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Methods
• Observational study
• Accuracy simulated patient handoffs
• SIM Center
• PGY1 and PGY2
• Evaluation q6 months (4)
• 2009 – 2010
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Simulated Patient Handoffs
• Three SIM handoffs
• Brief <30 seconds
• Distinct delivery methods• Face-to-Face• Video-message• Screen-based message (e-mail)
• Order randomized
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Tech-Enhanced HandoffVideo Message
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Video-BasedScreen-BasedFace-to-Face
Study Design
Trainee receives 3 handoffs
Sleep and preference survey
Trainee delivers 3 handoffs
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Outcome Measures
• Testing sessions video-recorded
• Reviewed x2 independent raters
• Quality Measures• % Word Accuracy• Errors of Omission • Errors of Commission• Appropriate Judgment
• Reliability, ICC >0.8 , Cronbach’s α >0.8
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Errors of Omission
I can’t remember the other ones…
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Errors of Commission
Bovine pericardium patch vs aortic valve?
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Appropriate Judgment
Is there anything else I need to do or know to take better care of these patients?
Yes, just check an INR on Mr Jones.
Mr Jones on coumadin, scheduled for hernia repair today….
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Results – Word Accuracy
FTF > V, S
V=S
T2>T1
PGY2=PGY1
P<0.05
* ** *
= == =
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Results – Errors of Omission
FTF> V, S
S>V
T2>T1
PGY2>PGY1
Lower values = better (fewer errors)
*** *
*
** *
P<0.05
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Results – Errors of Commission
FTF & S > V
FTF = S
T4>T3
PGY2=PGY1
Lower values = better (fewer errors)
* ** ** ** *
P<0.05
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Results – Appropriate Judgment
FTF>V
T4>T3
PGY2=PGY1***
*
P<0.05
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Sleep and Preference Survey
• # Sleep hours night before•Mean 5 ± 2•P=NS, all handoff quality measures
• Trainee Preference
73%
5%
15%
7%
Face-to-Face
Video
Screen
Other
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Limitations
• Novice learners
• Simulated setting
• No memory aids
• Same test q6 months
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Summary
• Face-to-face
• preferred
• better
• Room for improvement
• Training in handoffs needed
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Handing Over Patient Care:Is it just the old broken telephone game?
Benjamin Zendejas, MD, MSc
Shahzad M. Ali, MD
Marianne Huebner, PhD
David R. Farley, MD