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.
6. Review every patient. Residents should review every patient during the handoff, Arora says. The giver should verbally identify each patient and state all of the anticipated problems that may arise. Next, he or she should list the major medical issues and the to-do list the cross-cover practitioner needs to complete. The receiver should be an active listener, take notes, and read all of the items on the to-do list back to ensure that he or she understood everything.
7. Identify sick patients upfront. 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. This helps to ensure that the physician receiving the information understands the seriousness of the situation and asks the appropriate questions.
8. Explain the rationale. It's a common mistake for information givers to assume that receivers know everything that they know about the patient. Residents handing off patients to another physician should explain their rationale for each order.
"We encourage people to be as specific as possible and use concrete language," Arora says.
For example, it's common to note "check basic metabolic profile" in the handoff documentation. However, the resident should specify that he or she is concerned about the patient's potassium levels, not sodium levels.
9. Avoid nonstandard abbreviations. Many abbreviations have different meanings depending on who is reading them, Kogan says. For example, a medicine resident may abbreviate hyperlipidemia as "HL." If an oncology consult is called, the oncologist may interpret that as Hodgkin's lymphoma, which can create a lot of confusion, Kogan says.
10. Use if-then scenarios. Focusing the discussion on contingencies (e.g., if patient reacts this way, do X; if patient reacts that way, do Y) gives receiving physicians a clear understanding of what they should consider doing during their shifts.
Julie McCoy is an associate editor for the residency department at HCPro. For more residency news, please visit www.residencymanager.com.