Dataset Information

An institution-wide handoff task force to standardise and improve physician handoffs.

ABSTRACT:

Background

Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs.

Methods

An institution-wide physician handoff task force was developed to proactively address issues surrounding handoffs and to ensure a consistent approach to handoffs across the institution.

Results

This report discusses the authors' experiences with handoff standardisation, provider utilisation of a new electronic medical record-based handoff tool, and implementation of an educational curriculum; future work in developing hospital-wide policies and procedures for transfers; and the authors' consensus on the best methods for monitoring and evaluation of trainee handoffs.

Conclusion

The handoff task force infrastructure has enabled the authors to take an institution-wide approach to improving handoffs. The task force has improved patient care by addressing handoffs systematically and consistently and has helped create new strategies for minimising risk in handoffs.

SUBMITTER: Horwitz LI

PROVIDER: S-EPMC3463404 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

An institution-wide handoff task force to standardise and improve physician handoffs.

Horwitz Leora I LI Schuster Kevin M KM Thung Stephen F SF Hersh David C DC Fisher Rosemarie L RL Shah Nidhi N Cushing William W Nunes Judy J Silverman David G DG Jenq Grace Y GY

BMJ quality & safety 20120523 10

<h4>Background</h4>Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs.<h4>Methods</h4>An institution-wide physician handoff task force was developed to proactively address issues surrounding handoffs and to ensure a consistent approach to handoffs across the institution.<h4>Results</h4>This report discusses t ...[more]

PMID: 22626740

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Project description:IntroductionFew studies investigate the benefits of familiarity or continuity during physician-to-physician handoff of inpatients. Factors such as how recently physicians (MDs) have worked and successive days caring for patients increase continuity, and thus could lead to enhanced handoff efficiency. Evaluating the efficacy of MD scheduling to enhance continuity is currently subjective.MethodsAn MD group consisting of 9 attending physicians and 7 fellows redesigned its pediatric intensive care unit (PICU) coverage schedule with the goal of enhancing continuity of care. The attending PICU MDs were formally surveyed to rate the impact of the schedule change on continuity and efficiency (5 point Likert scale: 1 = worse, 3 = no change, 5 = better). A Handoff Continuity Score (HCS) was developed and used to analyze the 30-bed PICU MD schedule for continuity and handoff efficiency. MD service and call schedules were evaluated for 6-month periods before and after the schedule redesign. The HCS for each schedule was calculated by considering every shift change, or handoff, in the scheduling horizon, and assigning scores to oncoming physicians based on previous days worked. Specifically, for each handoff, each oncoming MD receives a score between 0 and 1, calculated as the summation of a series of 'familiarity factors', one for each recent day worked. The scores for all oncoming MDs are averaged to determine the score for that specific handoff, and the HCS is the average of all handoff scores. The HCS was incorporated into an integer programming (IP) model for scheduling MDs to maximize continuity. A z-test was used to assess the significance of improvement in the HCS.ResultsThe HCS before and after redesign was 0.57 and 0.68, respectively (19% increase, p < 0.01). Mean MD rating was 4.22 ± 0.56 for continuity, and 4.00 ± 0.65 for efficiency. With the goal of further improving the HCS and (partly) automating and streamlining the scheduling process, the IP was developed to populate physician service and night-call schedules while conforming to scheduling constraints; IP-generated schedules improved the HCS to 0.79 (39% increase).ConclusionsThe increased HCS was associated with the MD qualitative assessment of enhanced continuity and efficiency after implanting a schedule change. The IP identified the potential for additional scheduling improvements.

Project description:BackgroundSafe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions.MethodsUsing a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees' experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses.Results687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame.ConclusionsHealth systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.

Project description:ObjectiveAs a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage of physicians and nursing staff, new concepts of care are needed. The aim of this scoping review is to review the literature and examine the effects of task delegation to non-physician health professionals, with a further emphasis on inter-professional care.Research design and methodsSystematic searches were performed using the PubMed, Embase and Google Scholar databases to retrieve papers published between January 1994 and December 2017. Randomised/non-randomised controlled trials and studies with a before/after design that described the delegation of tasks from physicians to non-physicians in diabetes care were included in the search. This review is a subgroup analysis that further assesses all the studies conducted using a team-based approach.ResultsA total of 45 studies with 12,092 patients met the inclusion criteria. Most of the interventions were performed in an outpatient setting with type-2 diabetes mellitus patients. The non-physician healthcare professionals involved in the team were nurses, pharmacists, community health workers and dietitians. Most studies showed significant improvements in glycaemic control and high patient satisfaction, while there were no indications that the task delegation affected quality of life scores.ConclusionsThe findings of the review suggest that task delegation can provide equivalent glycaemic control and potentially lead to an improvement in the quality of care. However, this review revealed a lack of clinical endpoints, as well as an inconsistency between the biochemical outcome parameters and the patient-centred outcome parameters. Given the vast differences between the individual healthcare systems used around the world, further high-quality research with an emphasis on long-term outcome effects and the expertise of non-physicians is needed.

Dataset Information

An institution-wide handoff task force to standardise and improve physician handoffs.

Background

Methods

Results

Conclusion

Publications

An institution-wide handoff task force to standardise and improve physician handoffs.

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