Handoff Safety Curriculum

1. Handoff Safety Curriculum HUP Department Date

2. “Handoffs and Sign-Out”Verbal and Written • Review the importance of handoffs • Watch and critique videos of handoffs • Teach the components of safe written and verbal handoffs • Formal post-didactic observed handoffs

3. This is why… • Poor communication is the most common cause of medical errors nationally • JCAHO: 2006 National Patient Safety Goal requiring hospitals to implement standardized approach to patient handoffs • HUP Provider Survey: 70 Surgery, 35 Medicine, 25 Emergency, 23 NP/PAs • HUP GME 2012: Mandatory handoff curriculum and assessment for all new resident hires

4. Video Handoff Example: Good or Bad?

5. Case Scenario • Department specific

6. Keys to Good Verbal Handoffs • Location, location, location • As quiet as possible • Minimize interruptions • If you are worried about the patient…say it! • Give receiving provider an opportunity to ask questions and repeat back important facts • Review every patient • Follow the same format/order for all patients

7. SHOUT… it Out! S – Sick or Not Sick (include DNR, diagnosis) H – History and Hospital Course O – Objective Data (exam, vitals, results) U – Upcoming Plan, Dispo T – To Do (include rationale) Acronym modeled after Arora, V., et. al.

8. Covering Provider As a reminder, it is the responsibility of the incoming provider to sign in as the new covering provider after verbal handoff

9. Keys to a Good Written Signout • Standardize • Exclude irrelevant or outdated information • Update sign-out before every handoff!!! • Avoid non-standard abbreviations • Summarize findings. Do not cut and paste every result.

10. The “Checklist” Q11: How much information does the written/printed sign-out have? N = 124 respondents • Procedures • Diet and NPO orders • Acuity level • Code status, allergies, and contact • Recent VS, Labs, Exam • Antibiotic information • Infectious history • Updated problem list, correctly prioritized • Brief summary of hospital course • Important medication information • 24-48 care plan • Recap of recent/same day events • Med changes, procedures, clinical changes • Better anticipatory guidance % of Total Too much (10) Not enough (8) Right amount (40) Variable (66)

11. Keys to a Good Written Sign-out

12. Summary of “Best Practices” in Handoffs • Quiet Location • Minimize Interruptions • Standardize both written and verbal format as much as possible • Use anticipatory guidance and avoid anchoring bias • Make time for questions and clarifications