Strategies and Tools to Enhance Communication Among Health Care Providers

1. Strategies and Tools to Enhance Communication Among Health Care Providers Bonnie C. Desselle, MD Program Director LSUHSC Pediatric Residency Program

2. Communication Series Part 1: Hand – offs Part 2: Formal Presentations Part 3: Communication during Emergencies

3. Hand - Offs Mechanism of transferring information, responsibility and/or authority from one set of care-givers to another

4. Sentinel Events

5. Root Causes of Sentinel Events(1995-2005) -The Joint Commission of Accreditation of Hospitals

6. Call to Improve Handoffs • Joint Commission, 2006 • National Patient Safety Goal • World Health Organization, 2006 • Prevention of handover errors part of “High Fives” patient safety solutions • Institute of Medicine, 2008 • Teaching programs “should train residents in how to hand over their patients using effective communication.” • ACGME, 2010 • Programs must ensure and monitor effective, structured hand-over processes • Must ensure that residents are competent in the hand-over process

7. Group Discussion Characteristics of Worst and Best Sign-offs

8. Group Discussion Live demonstrations of sign-offs

9. Essential Elements for Pediatric Sign-out List • Demographics • Name • MRN • Unit/room number • Age • Weight • Gender • Allergies • Admit date • Attending physician/Service/Consults • Phone numbers and covering physician • History and Problem List • Primary diagnosis(es) • Chronic problems (pertinent to this admission/shift) • Current condition/status

10. Essential Elements for Pediatric Sign-out List • System based • Pertinent Medications and Treatments • Oral and IV medications • IV fluids • Blood products • Oxygen • Respiratory therapy interventions • Pertinent lab data • To do list • Check x-ray, labs, wean treatments • Include rationale

11. Essential Elements for Pediatric Sign-out List • Contingency Planning • What may go wrong and what to do • If this…then do this • Include rationale • What has/ has not worked before (e.g. responds to nasal suctioning) • Code status/family situations • Difficult family or psychosocial situations • Code status, especially recent changes or family discussions

12. Practice a sign out

13. Essential Elements for Receiver Readback/Summation: co-orientation Questions/clarifications Collaborative cross check

14. Other Essential Elements • Proper Environment: sterile cockpit • No distractions • Quiet place • Always face to face • Start with sickest patient • Never say “ This is not my patient….I am just covering for the night”

15. PGY- 1 • Essential Elements of Sign-out Giver Mastery • Patient identification • Patient background • Current conditions or current physical exam • Contingency plans • Overall general treatment plan

16. PGY-2 • 3 Essential Elements for Sign-out Receiver Mastery • Readback/summation: Co-orientation • Questions/clarifications • Solicit other overnight tasks for patient

17. PGY-3 • Has mastered giving and receiving sign-out • Working towards: • Collaborative cross check • Off topic discussion that include teaching points

18. Summary Effective exchange of information is vital during sign-outs Both the giver and receiver have specific roles and responsibilities Hopefully we have given you some tools to make your hand-offs more effective

20. Click to Show Funny Video