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Paths to Improved Patient Care

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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.

These tips will help improve your residents' handoffs skills:

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 space should include computers so residents can access medical information and electronic sign-out programs.

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 page residents only with emergency situations while trainees are engaged in handoffs.

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.

4. Use templates for sign-outs—preferably 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 prepopulate patient information, thereby cutting the time spent and the chance of errors.

5. Empower givers and receivers. Both parties should feel comfortable enough to ask the other practitioner to slow down or elaborate, Airan-Javia says.

6. Review every patient. Residents should review each patient during the handoff, Arora says. The giver should verbally identify each patient and state the anticipated problems. The receiver should take notes and read back all of the items on the to-do list to ensure that he or she understood everything.

7. Identify sick patients up front. If the patient is sick or the team is particularly concerned, the giver should say that at the beginning of the patient's handoff, says Airan-Javia.

8. Explain the rationale. It's common to note "check basic metabolic profile" in the handoff documentation. But the resident should specify that he or she is concerned about the patient's potassium levels, not sodium levels, for example.

Written by Julie McCoy on February 8.

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