Develop a Handoff Training Program

Julie McCoy, April 29, 2010

With more research showing that handoffs are essential to patient safety, the pressure is on for hospitals to teach physicians handoff techniques.

Despite this call to action, few training tools exist. Developing a toolbox of educational activities and assessments will give your residents the training and skills they need to conduct handoffs and preserve patient safety.

A didactic lecture is essential for framing the importance of the subject. Include the following topics in your lecture:

  • Why handoffs are important for patient safety
  • Examples showing the number of transitions of care patients may experience during a hospital stay
  • Examples of how a poor handoff can lead to medical errors
  • Specific criteria for excellent verbal and written handoffs

Additionally, review your hospital's procedures for handoffs during the lecture. For example, if your hospital uses an electronic sign-out system, show screenshots of the form to the audience, says Subha Airan-Javia, MD, a hospitalist and information technology physician advisor at the Hospital of The University of Pennsylvania, who trains residents and medical students on how to conduct handoffs.

This familiarizes physicians with the form and shows them the exact information they should include in the sign-out and how it should be formatted, Airan-Javia explains.

There are several ways to use role-playing during didactic lectures to drive lessons home.

One option is to use role-playing to highlight the systems-based issues that commonly contribute to breakdowns in handoff communication, says Vineet Arora, MD, MAPP, associate director of the internal medicine residency program at the University of Chicago Pritzker School of Medicine.

"We role-play a very bad handoff, and we ask them to figure out all of the different ways things went wrong," says Arora.

Debrief the participants, prompting discussion on the barriers that were present during the handoff. Ask them to identify issues related to:

  • Culture (e.g., the physician not prioritizing handoffs or following established procedures)
  • Communication (e.g., the use of vague terms or incomplete information)
  • Environment (e.g., distractions and interruptions that impede the established handoff procedure)

When developing role-playing scenarios, Airan-Javia recommends keeping them as realistic as possible. "We really tried to pull from our own experience of different patients and things that happened," she says.

Providing formal handoff training underscores to faculty members and residents that these exchanges of information must be a priority, Airan-Javia says, adding that you will start to see your department's culture shift as physicians and other members of the healthcare team view handoffs as essential to patient care and safety.

Julie McCoy is an associate editor with HCPro, Inc.'s Residency Department. For more residency news, please visit
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