A Systematic Review of Educational Resources for Teaching Patient Handover Skills

1. A Systematic Review of Educational Resources for Teaching Patient Handover Skills M. Masterson MD MSc Beng1,2, R. Gill MD1,3, M. Giuliani MBBS MEd1,4, P. Shrichand MPA1 1. Canadian Association of Internes and Residents, Ottawa2. Department of Anaesthesiology and Pharmacology, UBC, Vancouver3. Department of General Surgery, University of Alberta, Edmonton4. Department of Radiation Oncology, University of Toronto, Toronto

2. Introduction • Physicians are working fewer hours • Increased transfer of patient care, i.e. handover • Handover is time of increased risk to patients • Few residents get training in handover • between 10 and 40% in US and N Ireland • 30% of residents have been in situations that could have benefited from improved handover

3. Methods • Search in Multiple databases: • EMBase, Medline, HAPI, CINAHL, Sci/Soc Sci citation index, PsychINFO • English Language, 1990-2009, any profession • Search for Educational Resources on Handover • Search terms: educational models, teaching modules, shift change, sign over, signout, handoff, handover, transfer, MeSH heading “Shfit Reports”, “Professional Competence”, “Education”, “Teaching Methods” • Two independent reviewers • Data Abstracted • Intervention Population, Country, Educational Method, and Outcomes Measured

4. 22 excluded on review 5 unable to obtain 1644 excluded on title review 63 excluded on abstract review Results

5. Results: Demographics • 12 Studies included • 5 US, 5 UK, 1 Israel, 1 Australia, • None from Canada • 5 educational resources directed to residents, 3 to groups including physicians and 4 to other allied health providers

6. Results: Educational Models • 12 Studies included • 7 presented simulation or role-playing • Simulation well received by participants • Appreciate challenge of playing other providers’ role • Variety of simulation models • 8 suggested lectures • Lecture not as well received as observed handovers

7. Results: Outcomes • No studies show effects on morbidity/mortality • Reductions in omission error • Improvements in critical checks (i.e. ventilator/meds) • Handover: • Is an opportunity to teach/instill professionalism • Can be effectively taught as part of larger curricula

8. Discussion • Limited literature – 12 educational articles • No Canadian data • Simulation and role play • Most common • Well received by participants • Didactic sessions less well received

9. Discussion • Brief interventions improve: • user comfort • metrics of information transfer • Can be used as time to teach professionalism • No data on morbidity or mortality outcomes

10. Results: Summary of Papers

12. References • National Physician Survey, 2007, www.nationalphysiciansurvey.ca • Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. • Archives of Internal Medicine. 2006;166(11):1173-7. Borowitz SM, Waggoner-Fountain LA, Bass EJ, Sledd RM. Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey. Quality & Safety in Health Care. 2008;17(1):6-10 • Kennedy R, Kelly S, Grant S, Cranley B. Northern Ireland general surgery handover study: Surgical trainees' assessment of current practice. Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2009 Feb;7(1):10-3. • Sinha M, Shriki J, Salness R, Blackburn PA. Need for standardized sign-out in the emergency department: a survey of emergency medicine residency and pediatric emergency medicine fellowship program directors. Academic Emergency Medicine. 2007;14(2):192-6. • Nestel D, Kneebone R, Barnet A. Teaching communication skills for handover: perioperative specialist practitioners. Medical Education. 2005;39(11):1157-. • Chu ES, Reid M, Schulz T, Burden M, Mancini D, Ambardekar AV, et al. A structured handoff program for interns. Academic Medicine. 2009 March;84(3):347-52. • Berkenstadt H, Haviv Y, Tuval A, Shemesh Y, Megrill A, Perry A, et al. Improving handoff communications in critical care: utilizing simulation-based training toward process improvement in managing patient risk. CHEST. 2008;134(1):158-62. • Catchpole KR, De Leval MR, McEwan A, Pigott N, Elliott MJ, McQuillan A, et al. Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Pediatric Anesthesia. 2007 May;17(5):470-8. • Clark E, Squire S, Heyme A, Mickle ME, Petrie E. The PACT Project: improving communication at handover. Medical Journal of Australia. 2009 Jun;190(11):S125-S7. • Arora VM, Johnson JK, Meltzer DO, Humphrey HJ. A theoretical framework and competency-based approach to improving handoffs. Quality and Safety in Health Care. 2008 Feb;17(1):11-4. • Klaber RE, Macdougall CF. Maximising learning opportunities in handover. Archives of Disease in Childhood: Education and Practice Edition. 2009 August;94(4):118-22. • Cosgrove JF, Kilner AJ, Batcheolor AM. Training and assessment of competency in the transfer of criticaly ill patients. Anaesthesia. 2005, 60, 409-410 • Cleland JA, Ross S, Miller SC, Patey R. "There is a chain of Chinese whispers ...": empirical data support the call to formally teach handover to prequalification doctors. Quality & Safety in Health Care. 2009;18(4):267-71. • Klamen DL, Reynolds KL, Yale B, Aiello M. Students learning handovers in a simulated in-patient unit. Medical Education. 2009;43(11):1097-8. • Ledema R, Merrick ET, Kerridge R, Herkes R, Lee B, Anscombe M, et al. Handover - Enabling Learning in Communication for Safety (HELiCS): a report on achievements at two hospital sites. Medical Journal of Australia. 2009 Jun;190(11):S133-S6. Studies meeting inclusion criteria in bold