Desirable Features of an Interdisciplinary Handoff.
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ABSTRACT:
SUBMITTER: Sule AA
PROVIDER: S-EPMC8279443 | biostudies-literature | 2020 Jan-Dec
REPOSITORIES: biostudies-literature
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Desirable Features of an Interdisciplinary Handoff.
Sule Anupam Ashutosh AA Caputo Dean D Gohal Jaskaren J Dascenzo Doug D
JMIR nursing 20200101 1
Failure of communication of critical information during handoffs is one of the leading causes of medical errors, resulting in serious, yet preventable, adverse events in hospitals across the United States. Recent studies have shown that a majority of these errors occur during patient handoffs, with notable communication gaps in interdisciplinary handoffs. We suggest some features that would improve the handoff usability and effectiveness for interdisciplinary medical and nursing teams while pote ...[more]
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Project description:Objective1) To develop validity evidence for the use of the Verbal Handoff Assessment Tool (VHAT) and examine the reliability of VHAT scores, and 2) to determine whether implementation of a resident handoff bundle (RHB) was associated with improved verbal patient handoffs among pediatric resident physicians.MethodsIn a pre-post design, prospectively audio recorded verbal patient handoffs conducted at Boston Children's Hospital before and after implementation of the RHB were rated using the VHAT, which was developed for this study (primary outcome). Using generalizability theory, we evaluated the reliability of VHAT scores.ResultsOverall, VHAT scores increased after RHB implementation (mean 142 vs 191, possible score 0-500; P < .0001). When accounting for clustering according to resident physician, hospital unit, unit census, and patient complexity, implementation of the RHB was associated with a 63-point increase in VHAT score. Using generalizability theory, we determined that a resident's mean VHAT score on the basis of a handoff of 15 patients assessed by a single observer was sufficiently reliable for relative ranking decisions (ie, norm-based; generalizability coefficient, 0.81), whereas a VHAT score on the basis of a handoff of 21 patients would be sufficiently reliable for high-stakes, standard-based decisions (Phi, 0.80).ConclusionsVerbal handoffs improved after implementation of a RHB, although gains were variable across the 2 clinical units. The VHAT shows promise as an assessment tool for resident handoff skills. If used for competency or entrustment decisions, a resident's mean VHAT score should be on the basis of observation of verbal handoff of ≥21 patients.
| S-EPMC5504880 | biostudies-literature
Project description:Structured handoffs at transitions of care are vital components of patient safety. A safety culture survey showed that "handoffs and transitions" were among the lowest scoring dimensions at our hospital. We sought to improve physician handoffs and safety culture scores by implementing standardized handoff communication across multiple divisions of an academic pediatric department.MethodsWe used a modified learning collaborative model to implement an I-PASS program, including training, standardized verbal handoff processes, observation and feedback, and sustainment. The setting was the Department of Pediatrics (DoP) within a tertiary academic children's hospital encompassing 13 clinical divisions. The primary outcome was a change in the DoP staff physician "handoffs and transitions" score on the Agency for Healthcare Quality (AHRQ) Hospital Survey on Patient Safety Culture. Process measures included handoff duration and proportion of handoffs using the complete I-PASS mnemonic.ResultsFive hundred sixty-seven physicians from clinical divisions participated over 14 months. One hundred percent of eligible physicians completed an introductory online I-PASS training module. The "handoffs and transitions" score improved from 46% to 54% from 2018 to 2020. From May 2019 to February 2020, the proportion of observed handoffs with all five elements of the I-PASS mnemonic improved from 62% to 100%, and the duration of handoffs per patient did not change.ConclusionsWe successfully implemented an I-PASS program across an academic department of pediatrics. The departmental staff physician safety culture "handoff and transitions" score improved. The adherence to the I-PASS mnemonic improved. The duration of handoffs did not change over the study period.
| S-EPMC8970093 | biostudies-literature
Project description:BackgroundGestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother's and the offspring's risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking.ObjectiveThe aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature.MethodsWe designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews.ResultsWe identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior.ConclusionsThe feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps.Trial registrationClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652.
| S-EPMC9607927 | biostudies-literature
Project description:BackgroundIncreasing frequency of shift-to-shift handoffs coupled with regulatory requirements to evaluate handoff quality make a handoff evaluation tool necessary.ObjectiveTo develop a handoff evaluation tool.DesignTool development.SettingTwo academic medical centers.SubjectsNurse practitioners, medicine housestaff, and hospitalist attendings.InterventionConcurrent peer and external evaluations of shift-to-shift handoffs.MeasurementsThe Handoff CEX (clinical evaluation exercise) consists of 6 subdomains and 1 overall assessment, each scored from 1 to 9, where 1 to 3 is unsatisfactory and 7 to 9 is superior. We assessed range of scores, performance among subgroups, internal consistency, and agreement among types of raters.ResultsWe conducted 675 evaluations of 97 unique individuals during 149 handoff sessions. Scores ranged from unsatisfactory to superior in each domain. The highest rated domain for handoff providers was professionalism (median: 8; interquartile range [IQR]: 7-9); the lowest was content (median: 7; IQR: 6-8). Scores at the 2 institutions were similar, and scores did not differ significantly by training level. Spearman correlation coefficients among the CEX subdomains for provider scores ranged from 0.71 to 0.86, except for setting (0.39-0.40). Third-party external evaluators consistently gave lower marks for the same handoff than peer evaluators did. Weighted kappa scores for provider evaluations comparing external evaluators to peers ranged from 0.28 (95% confidence interval [CI]: 0.01, 0.56) for setting to 0.59 (95% CI: 0.38, 0.80) for organization.ConclusionsThis handoff evaluation tool was easily used by trainees and attendings, had high internal consistency, and performed similarly across institutions. Because peers consistently provided higher scores than external evaluators, this tool may be most appropriate for external evaluation.
| S-EPMC3621018 | biostudies-literature
Project description:IntroductionHandoffs have been shown to be a potential cause of communication failures, leading to possible inefficiencies and patient harm. We noticed that our CA-1 residents were struggling with patient handoffs and designed this simulation to improve their handoff skills.MethodsThis anesthesiology-specific simulation introduced learners to the perioperative handoff process. We designed it for anesthesiology learners, including junior residents, medical students, and student nurse anesthetists. The simulation centered upon an anesthesiology resident taking care of an ICU patient and handing that patient off to another anesthesiology provider, who took the patient to the OR. We charged learners with reviewing the patient's history and hospital course and giving a complete handoff. We evaluated learners on the completeness and quality of the handoff, as well as on their performance during the session.ResultsTwenty-seven learners participated in this handoff simulation. The participants reported that the simulation improved their understanding of the anesthetic implications of medical conditions and gave them a better understanding of the essential elements of a handoff. Learners also indicated that the debriefing portion of the simulation was effective in filling some of their medical knowledge gaps and improving their handoff skills.DiscussionThis simulation was found to be an effective educational experience for our CA-1 and CA-3 residents, medical students, and student nurse anesthetists. Feedback was positive from all learners. As a result, this simulation will be implemented in the early learning curriculum for all of our CA-1 residents.
| S-EPMC7083603 | biostudies-literature
Project description:The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education.Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs.Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach ? of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6?=?high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P?<?0.001 trend test). Two-way analysis of variance revealed no evidence of rater bias.Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.
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Project description:BackgroundDespite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking.AimOur purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance.SettingGraduate Medical Education (GME) orientation at an urban, academic medical center.ParticipantsEighty-four incoming residents from four residency programs participated in the study.Program descriptionThe curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, five-item checklist.Program evaluationPrior handoff experience in medical school was associated with higher checklist scores (23% none vs. 33% either third OR fourth year vs. 58% third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12% no training vs. 38% prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting.ConclusionsThe M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.
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Project description:The objective was to assess use of a physician handoff tool embedded in the electronic medical record by nurses and other non-physicians. We administered a survey to nurses, physical therapists, discharge planners, social workers, and others to assess integration into daily practice, usefulness, and accuracy of the handoff tool. 231 individuals (61% response) participated. 60% used the tool often or usually/always during a shift. Nurses (46%) used the tool for shift transitions and found it helpful for medical history (79%) but not for acquiring medication, allergy, and responsible physician information. Nurses (96%) and others (75%) rated the tool as accurate. Medical nurses rated the tool more useful than surgical nurses, and pediatric nurses rarely used the tool. The tool was integrated into the daily workflow of non-physicians despite being designed for physician use. Non-physicians should be included in the design and implementation of electronic patient handoff systems.
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Project description:IntroductionGood handoffs require teamwork, clear communication, a cognitively safe environment, and a good understanding of the patient's medical needs. Complex tertiary care training institutions require multiple handoffs over a patient's time in the hospital. Medical students need better handoff education. We designed a handoff training exercise using a simulated patient care environment for students to practice and observe multiple handoffs over time.MethodsAn initial large-group didactic session provides direct instruction on handoffs. In small groups, students are subsequently assigned roles as individual physicians in a chain of providers during a simulated patient hospitalization over several days, with an additional student as an observer. Blinded to any prior discussion, student physicians sequentially give and receive handoffs about the patient from a previous physician as their simulated hospital course evolves. The observer shares his or her insights, and a large-group structured debriefing exercise follows.ResultsIn both 2015 and 2016, we implemented this session with a cohort of 30 fourth-year medical students. Most recently we implemented this with chief residents, and a group of 20 third-year pediatric clerkship students. We reviewed a selection of the discussion guides and found reporters/ observers noted that participants stated the primary problem 95% of the time (19 of 20 handoffs), the patient acuity 90% of the time (18 of 20 handoffs), and a clear contingency plan 85% of the time (17 of 20 handoffs).DiscussionWe found students initially to be preoccupied with making correct clinical decisions instead of giving effective handoffs, and consequently we clarified details and adjusted clinical information to be more transparent. Results suggest the session achieves our goals of using a structured handoff method to communicate higher-level information and debrief effectively with peers. We envision this activity to be applicable to teaching handoffs to residents, nurses, and other health care professionals, as well as possibly in diverse clinical environments or in collaboration with outpatient providers.
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Project description:Each cerebral hemisphere initially processes one half of the visual world. How are moving objects seamlessly tracked when they traverse visual hemifields? Covert tracking of lateralized objects evokes a difference between slow-wave electrophysiological activity observed from contralateral and ipsilateral electrodes in occipitoparietal regions. This event-related potentials (ERP) waveform, known as contralateral delay activity (CDA) [1, 2], is sensitive to the number of objects tracked [1, 2] and responds dynamically to changes in this quantity [3]. When a tracked object crosses the midline, an inversion in CDA polarity revealed the dropping of the object's representation by one hemisphere and its acquisition by the other. Importantly, our data suggest that the initially tracking hemisphere continues to represent the object for a period after that object crosses the midline. Meanwhile, the receiving hemisphere begins to represent the object before the object crosses the midline, leading to a period in which the object is represented by both hemispheres. Further, this overlap in representation is reduced if the midline crossing is unpredictable. Thus, this process is sensitive to observer expectations and does not simply reflect overlapping receptive fields near the midline.
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