Handing Over Patient Care:Is it just the old broken telephone game?

Benjamin Zendejas, MD, MSc

Shahzad M. Ali, MD

Marianne Huebner, PhD

David R. Farley, MD

Transfer of Patient Care

• Sign-out

• Shift report

• Hand-over

• Handoff

?

Handoff

“the exchange between health professionals of information about a patient accompanying either a transfer of control over, or of responsibility for, the patient.”

Cohen MD, et. al. Qual Saf Health Care, 2010

The Joint Commission 2008

The Reality

• Handoff accuracy hinges on communication

• Communication is prone to human error

• Poor quality handoffs:• Adverse events• Near misses• Legal lawsuits

Communication andTech-Enhanced Handoffs

Face-to-Face

Written

Telephone

Computer

Study Aims

• Tech-enhanced vs face-to-face handoffs

• Handoff quality measures

• Trainee Preference

• Improvement over time

• Sleep and handoff accuracy

Methods

• Observational study

• Accuracy simulated patient handoffs

• SIM Center

• PGY1 and PGY2

• Evaluation q6 months (4)

• 2009 – 2010

Simulated Patient Handoffs

• Three SIM handoffs

• Brief <30 seconds

• Distinct delivery methods• Face-to-Face• Video-message• Screen-based message (e-mail)

• Order randomized

Tech-Enhanced HandoffVideo Message

Video-BasedScreen-BasedFace-to-Face

Study Design

Trainee receives 3 handoffs

Sleep and preference survey

Trainee delivers 3 handoffs

Outcome Measures

• Testing sessions video-recorded

• Reviewed x2 independent raters

• Quality Measures• % Word Accuracy• Errors of Omission • Errors of Commission• Appropriate Judgment

• Reliability, ICC >0.8 , Cronbach’s α >0.8

Errors of Omission

I can’t remember the other ones…

Errors of Commission

Bovine pericardium patch vs aortic valve?

Appropriate Judgment

Is there anything else I need to do or know to take better care of these patients?

Yes, just check an INR on Mr Jones.

Mr Jones on coumadin, scheduled for hernia repair today….

Results – Word Accuracy

FTF > V, S

V=S

T2>T1

PGY2=PGY1

P<0.05

* ** *

= == =

Results – Errors of Omission

FTF> V, S

S>V

T2>T1

PGY2>PGY1

Lower values = better (fewer errors)

*** *

*

** *

P<0.05

Results – Errors of Commission

FTF & S > V

FTF = S

T4>T3

PGY2=PGY1

Lower values = better (fewer errors)

* ** ** ** *

P<0.05

Results – Appropriate Judgment

FTF>V

T4>T3

PGY2=PGY1***

*

P<0.05

Sleep and Preference Survey

• # Sleep hours night before•Mean 5 ± 2•P=NS, all handoff quality measures

• Trainee Preference

73%

5%

15%

7%

Face-to-Face

Video

Screen

Other

Limitations

• Novice learners

• Simulated setting

• No memory aids

• Same test q6 months

Summary

• Face-to-face

• preferred

• better

• Room for improvement

• Training in handoffs needed

Handing Over Patient Care:Is it just the old broken telephone game?

Benjamin Zendejas, MD, MSc

Shahzad M. Ali, MD

Marianne Huebner, PhD

David R. Farley, MD