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

1. 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

2. Transfer of Patient Care • Sign-out • Shift report • Hand-over • Handoff ?

3. 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

4. The Reality • Handoff accuracy hinges on communication • Communication is prone to human error • Poor quality handoffs: • Adverse events • Near misses • Legal lawsuits

5. Communication andTech-Enhanced Handoffs Face-to-Face Written Telephone Computer

6. Study Aims • Tech-enhanced vs face-to-face handoffs • Handoff quality measures • Trainee Preference • Improvement over time • Sleep and handoff accuracy

7. Methods • Observational study • Accuracy simulated patient handoffs • SIM Center • PGY1 and PGY2 • Evaluation q6 months (4) • 2009 – 2010

8. Simulated Patient Handoffs • Three SIM handoffs • Brief <30 seconds • Distinct delivery methods • Face-to-Face • Video-message • Screen-based message (e-mail) • Order randomized

9. Tech-Enhanced HandoffVideo Message

10. Video-Based Face-to-Face Screen-Based Study Design Trainee receives 3 handoffs Sleep and preference survey Trainee delivers 3 handoffs

11. 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

12. Errors of Omission I can’t remember the other ones…

13. Errors of Commission Bovine pericardium patch vs aortic valve?

14. Appropriate Judgment Is there anything else I need to do or know to take better care of these patients? Mr Jones on coumadin, scheduled for hernia repair today…. Yes, just check an INR on Mr Jones.

15. P<0.05 * * * * = = = = Results – Word Accuracy FTF > V, S V=S T2>T1 PGY2=PGY1

16. P<0.05 * * * * * * * * Results – Errors of Omission FTF> V, S S>V T2>T1 PGY2>PGY1 Lower values = better (fewer errors)

17. P<0.05 * * * * * * * * Results – Errors of Commission FTF & S > V FTF = S T4>T3 PGY2=PGY1 Lower values = better (fewer errors)

18. P<0.05 * * * * Results – Appropriate Judgment FTF>V T4>T3 PGY2=PGY1

19. Sleep and Preference Survey • # Sleep hours night before • Mean 5 ± 2 • P=NS, all handoff quality measures • Trainee Preference

20. Limitations • Novice learners • Simulated setting • No memory aids • Same test q6 months

21. Summary • Face-to-face • preferred • better • Room for improvement • Training in handoffs needed

22. 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