Implementation of a standardized electronic tool improves compliance, accuracy, and efficiency of trainee-to-trainee patient care handoffs after complex general surgical oncology procedures

Background Duty-hour regulations have increased the frequency of trainee-trainee patient handoffs. Each handoff creates a potential source for communication errors that can lead to near-miss and patient-harm events. We investigated the utility, efficacy, and trainee experience associated with implem...

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Bibliographic Details
Published in:Surgery 2017-03, Vol.161 (3), p.869-875
Main Authors: Clarke, Callisia N., MD, Patel, Sameer H., MD, Day, Ryan W., MD, George, Sobha, MSN, Sweeney, Colin, BA, Monetes De Oca, Georgina Avaloa, MS, Aiss, Mohamed Ait, BS, Grubbs, Elizabeth G., MD, Bednarski, Brian K., MD, Lee, Jeffery E., MD, Bodurka, Diane C., MD, MPH, Skibber, John M., MD, Aloia, Thomas A., MD
Format: Article
Language:English
Subjects:
Communication
Electronic Health Records
General Surgery - education
Humans
Internship and Residency
Patient Handoff
Prospective Studies
Surgery
Surgical Oncology - education
Workflow
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Summary:Background Duty-hour regulations have increased the frequency of trainee-trainee patient handoffs. Each handoff creates a potential source for communication errors that can lead to near-miss and patient-harm events. We investigated the utility, efficacy, and trainee experience associated with implementation of a novel, standardized, electronic handoff system. Methods We conducted a prospective intervention study of trainee-trainee handoffs of inpatients undergoing complex general surgical oncology procedures at a large tertiary institution. Preimplementation data were measured using trainee surveys and direct observation and by tracking delinquencies in charting. A standardized electronic handoff tool was created in a research electronic data capture (REDCap) database using the previously validated I-PASS methodology (illness severity, patient summary, action list, situational awareness and contingency planning, and synthesis). Electronic handoff was augmented by direct communication via phone or face-to-face interaction for inpatients deemed “watcher” or “unstable.” Postimplementation handoff compliance, communication errors, and trainee work flow were measured and compared to preimplementation values using standard statistical analysis. Results A total of 474 handoffs (203 preintervention and 271 postintervention) were observed over the study period; 86 handoffs involved patients admitted to the surgical intensive care unit, 344 patients admitted to the surgical stepdown unit, and 44 patients on the surgery ward. Implementation of the structured electronic tool resulted in an increase in trainee handoff compliance from 73% to 96% ( P  
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2016.09.004