Improving Transitions of Care, Handoffs and Coordination Across Units
Milestones to Teach and Evaluate Handoffs
1
Milestones to Teach and Evaluate Handoffs Vineet M. Arora MD MAPP, Jeanne M. Farnan MD MHPE, Holly J. Humphrey MD University of Chicago, Pritzker School of Medicine Background Methods Conclusion •Funding: AHRQ 1R03HS018278-01 & Department of Medicine Medical Educa and Clinical Excellence Award Needs assessment for clinical exposure & participation in handoffs Milestones for handoff education & evaluation developed reviewed by external experts for content validity Using handoff milestones, it is possible to develop and implement handoff teaching and evaluation across learner levels from medical student to faculty publications, speaking & web platforms MergeLab on YouTube [email protected] Next Steps Objective: To develop and implement handoff teaching and evaluation that address milestones in handoff education from medical student to faculty MS3 trained on how to turn H&P into written signout & New MS4 taught how to verbally signout before subinternship Using case-based workshops & simulation, graduating MS4 & incoming interns practice giving & receiving handoffs University of Chicago’s vertically integrated undergraduate & graduate medical education structure development & implementation of education & evaluation across continuum of medical training Learner should be able to perform… Teaching Tools Learner should be able to know… Evaluation 3 rd year student Understand the importance of handoffs as a cause of errors Function & content of a written signout Common problems in written sign-out Assess written signouts to identify defects Create written signout from admitting H&P Update written signout information Ensure HIPAA compliance Pocket Card Mock chart to signout exercise Written signout checklist 4 th year student/ incoming intern Understand function & common pitfalls of verbal handoffs Know strategies for effective communication for verbal handoffs Provide a complete handoff (written and verbal) using effective communication strategies on patients they admit Paper tear Pocket card Case–based exercise Handoff CEX- Sender Early to middle intern Know strategies for receiving a handoff Clinical reasoning for common issues arising when cross- covering Receive verbal handoff for larger numbers of patients with no prior knowledge (i.e. night float) Basic evaluation of cross-cover patients Document and communicate overnight events Sender/ Receiver pocket card XCover Cases Handoff CEX- Receiver Audit cross-cover note Middle to late intern Understand handoffs as a process Recognize systems issues in handoff errors Understand near misses and adverse events due to poor handoffs Identify systems issues preventing effective handoffs Use process improvement to improve handoffs Identify & reflect on handoff errors Teaching video with checklist Process map tutorial Peer Evaluation Resident Understand theories of communication Evaluation and feedback in improving handoffs Teach & model strategies for effective handoffs Supervise handoffs Evaluate & provide feedback on handoffs Paper tear exercise OSHE Handoff CEX Attending Principles of effective handoff education How to evaluate handoffs Review anticipatory guidance on rounds Supervise, evaluate & provide feedback on handoffs Signout as part of plan Handoff CEX Census audit Education & evaluation tools created along milestones Implementation via working with med school & residency curriculum committees Graduating MS4 practice sending and receiving handoffs in case-based workshop as part of ‘Capstone Course’ Incoming intern reviews H&P and watches interval events video as part of Observed Simulated Handoff Exercise Concerns voiced over handoffs after 2003 ACGME duty hour limits 2008 – IOM recommends all residents receive handoff education Tools to teach & evaluate handoffs lacking Residents receive training in supervising & evaluating handoffs Faculty development in how to incorporate handoff teaching into daily rounds is ongoing Competency-based peer evaluation Handoff CEX tool for observation Results Acknowledgments Julie Johnson, PhD, Leora Horwitz, MD
-
Upload
abim-foundation -
Category
Documents
-
view
4 -
download
0
description
Transcript of Milestones to Teach and Evaluate Handoffs
Milestones to Teach and Evaluate Handoffs Vineet M. Arora MD MAPP, Jeanne M. Farnan MD MHPE, Holly J. Humphrey MD
University of Chicago, Pritzker School of Medicine
Background
Methods
Conclusion
•Funding: AHRQ 1R03HS018278-01 &
Department of Medicine Medical Education
and Clinical Excellence Award
Needs assessment for clinical exposure & participation in handoffs
Milestones for handoff education & evaluation developed reviewed by external
experts for content validity
Using handoff milestones, it is possible to develop and implement handoff teaching and evaluation across learner levels from medical student to faculty
Disseminate findings via national meetings, publications, speaking & web platforms
MergeLab on YouTube
Next Steps
Objective: To develop and implement handoff teaching and evaluation that address milestones in handoff education from medical student to faculty
MS3 trained on how to turn H&P into written signout & HIPAA
New MS4 taught how to verbally signout before subinternship
Using case-based workshops & simulation, graduating MS4 & incoming interns practice giving & receiving handoffs
University of Chicago’s vertically integrated undergraduate & graduate medical education structure development & implementation of education & evaluation across continuum of medical training
Learner should be able to perform… Teaching ToolsLearner should be able to know… Evaluation
3rd year student
Understand the importance of handoffs as a cause of errorsFunction & content of a written signoutCommon problems in written sign-out
Assess written signouts to identify defectsCreate written signout from admitting H&P Update written signout information Ensure HIPAA compliance
Pocket CardMock chart to signout exercise
Written signout checklist
4th year student/
incoming intern
Understand function & common pitfalls of verbal handoffsKnow strategies for effective communication for verbal handoffs
Provide a complete handoff (written and verbal) using effective communication strategies on patients they admit
Paper tear Pocket cardCase–based exercise
Handoff CEX- Sender
Early to middle intern
Know strategies for receiving a handoff Clinical reasoning for common issues arising when cross-covering
Receive verbal handoff for larger numbers of patients with no prior knowledge (i.e. night float)Basic evaluation of cross-cover patientsDocument and communicate overnight events
Sender/Receiver pocket card XCover Cases
Handoff CEX-ReceiverAudit cross-cover note
Middle to late intern
Understand handoffs as a processRecognize systems issues in handoff errorsUnderstand near misses and adverse events due to poor handoffs
Identify systems issues preventing effective handoffsUse process improvement to improve handoffsIdentify & reflect on handoff errors
Teaching video with checklist Process map tutorial
Peer Evaluation
ResidentUnderstand theories of communication Evaluation and feedback in improving handoffs
Teach & model strategies for effective handoffsSupervise handoffsEvaluate & provide feedback on handoffs
Paper tear exerciseOSHE
Handoff CEX
AttendingPrinciples of effective handoff education How to evaluate handoffs
Review anticipatory guidance on roundsSupervise, evaluate & provide feedback on handoffs
Signout as part of planHandoff CEX
Census audit
Education & evaluation tools created along milestones
Implementation via working with med school & residency curriculum committees
Graduating MS4 practice sending and receiving handoffs in case-based workshop as part of
‘Capstone Course’
Incoming intern reviews H&P and watches interval events video as part of Observed Simulated Handoff Exercise
Concerns voiced over handoffs after 2003 ACGME duty hour limits2008 – IOM recommends all residents receive handoff educationTools to teach & evaluate handoffs lacking
Residents receive training in supervising & evaluating handoffsFaculty development in how to incorporate handoff teaching into daily rounds is ongoingCompetency-based peer evaluation
Handoff CEX tool for observation
Results
Acknowledgments
Julie Johnson, PhD, Leora Horwitz, MD
