Handoff skills continue to be a critical part of resident training. Few large‐scale studies exist to assess the most effective method 1c teach proper handoff skills.
A prospective, randomized, controlled trial was conducted to explore the effectiveness of cognitive simulation to teach handoff skills compared to control. Eighty‐nine internal medicine and transitional year interns in 4 training programs were assigned to an interactive didactic workshop combined with a cognitive simulation exercise or usual experiential teaching, A previously studied, standardized handoff method utilizing the acronym l‐SWITCH (Idenlifiers, Seventy of illness, Working problems, Interventions on anticipated problems, Tests/consults pending. Code status, History] was introduced duhng the didactic session, followed by a cognitive simulation, where interns practiced their handoff skills using simulated clinical cases. Over a 7‐month period (September 2008‐March 2009), handoff performance was evaluated by PGY‐2 and PGY‐3 residents blinded to the interns' inlervention allocation. In addition, participating interns were surveyed on several educational outcomes.
Handoff interactions reviewed among the randomized interns did not show a significant difference in the simulation group compared tc controls in reported errors/intern/night In aggregate. However, subanalysis of data in the first 4 months of the study, in 2 of the 4 study institutions using a dedicated night‐float system did show a strong trend toward improved handoff performance and error reduction in simulation versus control (adjusted risk ratio 0.54. P = 0.08). Additional analysis in the pilot institution with a dedicated night‐float and geographic units, showed a significant (P = 0.03) improvement in handoff performance in the simulation group versus controls in the first 4 months of the study. Changes in self‐reported educational outcomes were significantly different in the simulation versus control group in the interns' perceptions of their ability to prepare a complete written handoff, prepare overnight resident to handle cross‐cover of patients, and have adequate handoff skills (P < 0.05).
This multi‐institution study reveals that standardized, structured handoff education using simulation results in variable outcomes in handoff performance based in part on local handoff practices and environment at the teaching institution. However, educational outcomes are favorable based on intern evaluation, indicating the promise QI simulation in handoff training.
P. Watson, none; A. Lukowski, none; J. Han, none.
To cite this abstract:Watson P, Lukowski A, Han J. Innovative Strategies That Improve Clinical Handoff (l‐Switch) Phase 3: Multi‐Institutional Randomized Controlled Trial Evaluating the Educational and Performance Effect of Cognitive Simulation on Resident Handoffs. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 202. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/innovative-strategies-that-improve-clinical-handoff-lswitch-phase-3-multiinstitutional-randomized-controlled-trial-evaluating-the-educational-and-performance-effect-of-cognitive-s/. Accessed November 14, 2019.