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Resident Handover: Need for Structured Curriculum and Quality Outcome Studies

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Abstract

Objective

The aim of this study was to investigate the efficacy of a structured handoff curriculum to increase competency and efficiency at handoff, improve resident perception of handoff, and impact patient outcomes.

Methods

Trained faculty assessed residents (n = 15) at a single center using a validated evaluation tool measuring the following: organization/efficiency, communication skills, content, clinical judgment, and humanistic qualities/professionalism, before and after the implementation of the standardized verbal handover tool, SAFETIPS [1]. A nonvalidated faculty observation tool was utilized to evaluate residents’ ability to prioritize and organize verbal handoff. Residents completed a qualitative survey evaluating perceptions of handover. Patient outcome parameters were measured before and after implementation of the handover curriculum.

Results

All faculty ratings of resident handoff significantly improved, with mean changes ranging from 1.2 to 1.9 points (p < 0.05 for all questions, n = 11). Using matched data, handover times in minutes per patient did not change significantly. Average scores from the nonvalidated questions improved to 0.45 (n = 11, p = 0.24, CI = −0.36–1.27). Pre- and post-intervention periods did not differ significantly on the rates of patient outcome parameters. Residents reported the standardized handover system made verbal handover more concise, complete, and accurate.

Conclusions

Formalized handover curriculum significantly improved key areas of resident handover including organization/efficiency, communication skills, content, clinical judgment, and humanistic qualities/professionalism but failed to show improvements in selected objective patient outcome measures.

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Abbreviations

ACGME:

Accreditation Council for Graduate Medical Education

IOM:

Institute of Medicine

PMET:

Pediatric Medical Emergency Team

RC:

Residency Committee

SERS:

Safety Event Report System

TJC:

The Joint Commission

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Acknowledgements

The authors thank Wendy Van Ittersum, MD; Katie Pestak, MD; Rolly Chawla, MD; Michele Marks, MD; Rachi Gupta, MD; Lori Griffeths; Allison Brindle, MD; Allan Cohen; Carla Torress, MD; Marc Ricks, MD; Arnaldo Zaya Santiago, MD; Meghan Drayton-Jackson, MD; the intern and resident classes of 2012-2014, Sarah Worley and Mary Kay Molzan.

Author information

Authors and Affiliations

  1. Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, 9500 Euclid Avenue, Cleveland, OH, 44194, USA

    Justen M. Aprile, Ben D. Reed, Shankar Baskar & Sangeeta Krishna

  2. Penn State College of Medicine, Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Mail Code H085, 500 University Drive, PO Box 850, Hershey, PA, 17033-0850, USA

    Bettina M. Aprile

Authors
  1. Justen M. Aprile
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Contributions

Justen M Aprile: Dr. Aprile was the primary investigator. He conceptualized and designed the study, participated in the data collection and analysis, drafted the preliminary manuscript, and approved the final paper as submitted. Benjamin D Reed and Shanker Baskar: Drs. Reed and Baskar carried out the data collection, interpretation, and analysis. They contributed substantially toward the initial draft and later reviewed and revised the manuscript for final submission. Bettina M Aprile: Dr. Aprile participated in the conceptualization and design of the study. She participated in the data interpretation, substantial editing of draft versions, and final approval of the manuscript for final submission. Sangeeta Krishna: Dr. Krishna was the study mentor. She assisted with the study design and implementation. She participated in the data collection and interpretation, draft composition, and ultimately approved the manuscript for final submission.

Corresponding author

Correspondence to Bettina M. Aprile.

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Financial Disclosure

The authors have indicated that they have no financial relationships relevant to this article to disclose.

Funding Disclosure

The authors have indicated that they have no funding support to disclose.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

What’s New: Patient handover is important, and formalized curriculums exist to improve communication and ensure effective transitions. Objective patient outcomes and an understanding of how they correlate with handover curriculum remain challenging. Our formalized curriculum significantly improved key areas of resident handover.

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Aprile, J.M., Reed, B.D., Baskar, S. et al. Resident Handover: Need for Structured Curriculum and Quality Outcome Studies. Med.Sci.Educ. 27, 281–293 (2017). https://doi.org/10.1007/s40670-017-0395-3

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