Handoffs of hospitalized patients represent critical points in patient care. Poor quality handoffs carry the risk of poor outcomes for patients and physicians. The Joint Commission and Society of Hospital Medicine (SHM) have published best practices for handoffs.
The goal of this quality improvement project is to standardize the elements of the handoff of hospitalized patients by internal medicine residents according to best practices by standardizing the elements of the verbal and written handoff with: 1) a standard computerized template across the facilities 2) a verbal script of required clinical information 3) Feedback to the intern with real examples from their own signouts We expect to decrease variation in practice patterns, decrease confusion among practitioners, and improve clinical outcomes in the long term.
In an effort to improve the quality of written handoffs, which serve as the basis for verbal handoffs, we convened a task force of internal medicine residents, led by a faculty hospitalist. The task force received support from the medical school leadership (Office of Patient Safety and Quality Improvement and Center for Patient Safety) and the internal medicine residency. The intervention consisted of the following: During one month all interns at Jackson Memorial Hospital and University of Miami Hospital ward teams were shown an instructional video the first day of rotation by chief medical residents. This video taught a mnemonic DPAC, which contained 10 elements of a handoff meeting Joint Commission and SHM best practices. Residents were shown same video one week later on the first day of their rotation told to reinforce teaching with their interns. Abstractors reviewed handoffs for compliance with 10 metrics of DPAC throughout the rotation. A letter was sent to interns during the rotation with feedback on performance. The letter specifically gave each intern feedback on adherence to 10 metrics. They were given specific examples from their own computerized handoffs. There was not a standard computerized template for both facilities.
Preintervention, our residents were most deficient in descending order of the following 5 metrics: Illness severity, current condition at handoff, checklist for next shift, anticipatory guidance, and reason for admission. Excellent results were seen in allergies, code status, active conditions, chronic conditions, and patient demographics. Over one month, we were able to decrease our deficiencies in the 5 areas of need by nearly 20%. Further work will demonstrate adherence to DPAC over a long term, standardize the template for both facilities, observe adherence to DPAC in verbal handoffs, and demonstrate a benefit to patient outcomes. Culture change on handoffs requires multiple methods of teaching and reinforcement.
To cite this abstract:Manjarrez E, Porteous H, Figueroa J, Moreno M, Hoang M. A Novel Approach to Teaching Handoffs to Internal Medicine Residentsa Pilot Project. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97693. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/a-novel-approach-to-teaching-handoffs-to-internal-medicine-residentsa-pilot-project/. Accessed September 18, 2019.