Improving Handoff Processes in Healthcare Residency Programs
A detailed exploration of the need for effective handoff processes in healthcare residency programs to enhance patient safety and care continuity. The study highlights dissatisfaction among residents and faculty regarding the current handoff system, leading to negative patient outcomes. It discusses the mandates by ACGME and TJC, emphasizing the importance of structured handover processes. The new handoff process is set to start on July 1st, 2011, with ongoing improvements until July 1st, 2012.
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Department Name PROVIDER HANDOFF PROVIDER HANDOFF RECOMMENDATIONS RECOMMENDATIONS JUNE 28 JUNE 28TH TH, 2011 , 2011
Why Are We Doing This? ACGME is mandating that all residency programs monitor and ensure effective, structured handover processes in order to facilitate both continuity of care and patient safety TJC 2008 National Patient Safety Goals requirement regarding standardization of handoffs Results of our own in house survey that demonstrated resident & faculty dissatisfaction with current process along with patient safety
Results Handoff Satisfaction UNM UNM Adult ED Residents & Attendings (n=42) "I don t think the current ED handoff process needs improvement at my institution" 25 20 15 10 5 0 Strongly Disagree Disagree Neutral Agree Strongly Agree 54 % responded Disagree 62 % responded Strongly Disagree or Disagree
Results - Negative Outcome UNM UNM Adult ED - Residents & Attendings (n=42) Negative patient outcomes result due to poor, inadequate or incomplete handoffs 20 18 16 14 12 10 8 6 4 2 0 3 to 4 Times Per Handoff1 to 2 Times Per Handoff Once Every Few Handoffs Once Every 10 Handoffs Rare Occurrence 42% responded Once Every Few 57% responded 1-2 times per handoff or Once every Few
Results - Negative Outcome Pres Presbyterian ED (n=32) Negative patient outcomes result due to poor, inadequate or incomplete handoffs 18 16 14 12 10 8 6 4 2 0 3 to 4 Times Per Handoff 1 to 2 Times Per Handoff Once Every Few Handoffs Once Every 10 Handoffs Rare Occurrence 53% responded Once Every Few 84% responded Once every 10 or Rare Occurrence
When? The new handoff process will officially go into effect July 1st, 2011 Changes to the handoff process will be a dynamic process and will occur throughout the year Final recommendations will be made on July 1st, 2012
Background Handoff survey was sent to the residents and faculty at UNM in March, 2011 Sklar, McLean, Crandall & Heilman Handoff process team was then created to implement changes to standardize the process Sklar, McLean, Webb, Heilman & Lahr Recommendations are based on the most up- to-date research on ED based handoffs and the UNM ED based survey done earlier this year
What are the changes? Preparation for Handoff Run the List within the hour leading up to the shift change with the attending Re-evaluate high-risk patients within the hour leading up to handoff Write down key lab values for acutely ill and complicated patients within thirty minutes of handoff
What are the changes? Handoff PLAN ED Patient (age, sex, name, room number and chief complaint) Label with working diagnosis or differential diagnosis Assessment (key elements of history, physical exam, labs, diagnostic imaging) Next steps and nursing assessment (pending labs, diagnostic imaging, consultants) Everything else (social issues, handed off before, systems issues) Disposition
What are the changes? Handoff General Guidelines Be on time and prepare for handoff early so that handoffs can start when scheduled Organize handoffs by doing selected bedside waking rounds Minimize interruptions! Officially admitted patients Spend approximately 5 minutes on clinical teaching
What are the changes? Post Handoff Within 15 minutes of the end of handoff, the accepting resident should assign himself or herself as the resident provider in the FirstNet tracking system Within the first 2 hours of the shift, patients that were handed off should have had their chart, laboratory and other findings reviewed and the resident should have physically introduced himself or herself
Next Steps Try out the new recommendations during the month of July Will have a discussion session on July 27th at Wednesday conference for feedback and suggestions Works in progress Nursing involvement in handoff process Electronically generated handoff sheet
