Use of Rapid Pdsa Cycles to Improve Pediatric Resident Handoffs

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97692


Every handoff of patient care between physicians poses a risk for error. New duty hours have increased the number of handoffs occurring between residents. Residents must be trained to deliver accurate, consistent, and efficient handoffs. Studies have shown that handoffs are most effective when performed face to face with minimal interruptions, incorporate contingency plans, employ a computer–based system, and offer the opportunity to ask questions.


To improve resident handoff accuracy, efficiency, and consistency using rapid cycle plan–do–study–act (PDSA) interventions. Some of these interventions include a mnemonic–based structure for verbal handoffs and a corresponding computer–based printed document that is integrated into the hospital electronic medical record (EMR).


A preliminary survey showed that the residents perceived their handoff process as adequate though they acknowledged the omission of key elements. Resident–led PDSA cycles were implemented and assessed on a monthly basis. A mnemonic (SIGNOUT?) was introduced in an attempt to provide structure to oral handoffs; however, this particular mnemonic was perceived as cumbersome, and in response, a more streamlined mnemonic (ANTICipate) was adopted and assessed. An EMR–integrated handoff document was created that corresponded to the new mnemonic. Residents were surveyed about their perceptions of the efficiency and accuracy of their handoffs both before and after the institution of the new system. Additionally, the time spent to complete each handoff was recorded for 8 weeks before and 8 weeks after the new system was introduced. Modifications to the oral handoff mnemonic, written handoff document, and handoff process have been implemented based on these results, with further PDSA cycles to be used to continue to streamline the resident handoff process.


Excellent handoffs are critical to the safe transfer of patient information between resident physicians. Resident involvement in frequent PDSA cycles to improve the handoff system has led to multiple changes and timely improvements in the handoff process.

To cite this abstract:

Kleifgen B, Combs D, Walker G, Franke H, Cramton R. Use of Rapid Pdsa Cycles to Improve Pediatric Resident Handoffs. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97692. Journal of Hospital Medicine. 2012; 7 (suppl 2). Accessed April 25, 2019.

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