Innovative Strategies Which Improve the Clinical Handoff (I‐SWITCH) Phase 1: Development of a Cognitive Handoff Simulation

1Internal Medicine, Henry Ford Hospital, Detroit, MI
2Internal Medicine, Henry Ford Hospital, Detroit, MI
3Internal Medicine, Henry Ford Hospital, Detroit, MI

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 100

Background:

With the evolution of ACGME duty‐hour requirements, there are an increasing number of patient handoffs. Much of the handoff literature has focused on tools to assist residents in the handoff process; however, few studies have investigated how to educate residents on the cognitive skills required to optimize the clinical handoff process.

Purpose:

To develop an educational process for inpatient handoffs using cognitive simulation training focused on factual knowledge and information processing for handoff education.

Description:

As part of a prospective randomized control trial of 36 categorical and 3 preliminary internal medicine residents, 13 residents participated in a cognitive handoff simulation. This workshop involved the application of a standardized method of clinical hand‐off information using the I‐SWITCH acronym (I — identifiers, S — severity of illness, W — working problems, I — interventions of anticipated problems, T — pending tests/consults, C — code status, H — pertinent history). Key components of an effective cognitive simulation were incorporated into our handoff educational process. The format of the workshop was similar to the Stanford Faculty Development model. Educational outcomes included adherence to the I‐SWITCH model, with special emphasis on development of skills related to problem anticipation, assessment of severity of illness and overall communication skills.

Table 1. Components of a Simulation Program

Conclusions:

This is the first attempt to describe a cognitive simulation aimed specifically at improving performance during the clinical handoff. Our results suggest this cognitive simulation was well received by the interns involved. All the intern participants agreed or strongly agreed that the overall exercise was very helpful and prepared them well for handoffs. On faculty observation and subjective comments, the participants developed a greater awareness of the basic components of the handoff with special emphasis on severity of illness and anticipation of problems following clinical handoff. In their peer and self‐assessments, many of the interns stated that seeing themselves and others perform on video was a useful element of the simulation. This is an educational tool that cannot only be applied to trainees but to hospitalists as well. Applying this cognitive simulation exercise to improve handoffs could improve patient safety outcomes.

Author Disclosure:

J. Han, none; A. Lukowski, none; P. Watson, none.

To cite this abstract:

Han J, Lukowski A, Watson P. Innovative Strategies Which Improve the Clinical Handoff (I‐SWITCH) Phase 1: Development of a Cognitive Handoff Simulation. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 100. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/innovative-strategies-which-improve-the-clinical-handoff-iswitch-phase-1-development-of-a-cognitive-handoff-simulation/. Accessed June 26, 2019.

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