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10 Ways to Improve Handoffs in Your Hospital

Julie McCoy, February 8, 2010

The way the medical community views patient handoffs is evolving. Handoffs were once seen simply as the last thing physicians did before leaving the hospital. Now, more physicians realize it's a skill that needs to be taught, practiced, assessed, and improved upon.

It's imperative to instill proper handoff practices in physicians during their training, says Vineet Arora, MD, MAPP, associate director of the internal medicine residency program at the University of Chicago Pritzker School of Medicine.

The following 10 tips will help improve your residents' handoffs skills and preserve patient safety:

1. Designate a quiet space where handoffs occur. Having a room or quiet area where residents can meet to discuss patients in private with few interruptions is ideal, Arora says. This room should include computers so residents can access medical information and electronic sign-out programs. Consider keeping food in that room as extra incentive for residents to conduct handoffs there, Arora suggests.

2. Reduce interruptions. Teach residents to avoid distractions caused by pagers, phone calls, and other tasks during handoffs, says Subha Airan-Javia, MD, a hospitalist and IT physician advisor at the Hospital of The University of Pennsylvania in Philadelphia, who also trains residents and medical students on how to conduct handoffs. Alert nurses that they should only page residents with emergency situations while trainees are engaged in handoffs.

If an interruption occurs, residents should begin the discussion of the patient over again. This ensures that residents giving information don't lose their train of thought and skip important details, Airan-Javia explains.

3. Set specific times for handoffs. Of course, the reality of this depends on the setting. Some rotations and schedules will be more conducive to specific handoff times than others. "Let's say the residents plan to leave at 1 p.m., then at 12 p.m., all of the post-call people should be signing out," Airan-Javia says.

4. Use templates for sign-outs. Use computerized templates, if available, says Jennifer Kogan, MD, assistant professor of internal medicine at the Hospital of The University of Pennsylvania. With templates, residents get used to seeing information in the same places, which makes locating patient data easier. Electronic templates can also pre-populate patient information, such as medical record number and date of birth, thereby cutting the time residents spend filling out the document. Prepopulated templates also reduce data entry errors that often occur with manual entry, Airan-Javia says.

5. Empower givers and receivers. It's common for givers or receivers of handoff information to hold back questions or skip details during handoffs because they feel bad about keeping the other person. Both parties should feel comfortable enough to ask the other practitioner to slow down or elaborate, Airan-Javia says.

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