Melissa Held, M.D. - University of Connecticut School of Medicine; Edwin Zalneraitis, M.D. - University of Connecticut School of Medicine
Purpose: In 2006, JCAHO required that organizations implement a standardized approach to handoff communications. Unfortunately, few pediatric residents or sub-interns receive the requisite hand-over education, evaluation and feedback to ensure development of competence in this activity. We created a hand-over curriculum based on development of "milestones" as learners become more proficient in the skill. Goals included: mastering transfer of clinical information at hand-overs, ensuring seamless continuum of care, reduction of errors related to information transfer, and improvement of the quality of the patient/family experience around the clock.
Methods: Educational sessions were conducted in the Spring 2011 and new intern and subI orientation. Sessions combined didactics on the importance of hand-overs, use of the verbal mnemonic "SIGNOUT" and opportunities for practice. A faculty member would periodically attend hand-over sessions, give feedback and complete an evaluation form. SubIs were surveyed in January 2012 asking when during medical school they had learned hand-overs, what educational methods were most helpful, and comfort level with hand-overs going into residency.
Results: The hand-over curriculum activities and outcomes were linked to relevant ACGME areas of competence and correlative assessment tools. Learners received written and verbal feedback by faculty and senior residents. The feedback was included in the final written evaluation of the inpatient rotation for all learners. Preliminary data shows that 91% of subI's reported learning how to hand-over patient information during their fourth year, specifically during their Pediatric sub-intern rotation (total n=11). Seventy percent reported "senior resident role-modeling hand-overs" was the most effective educational method, followed by "watching interns hand-over", and then use of the "SIGNOUT" tool.
Discussion: We have successfully implemented a unique hand-over curriculum at our institution based on reaching "milestones" in this skill. By providing educational opportunities, periodic observation of hand-overs by faculty, feedback and incorporation in rotation evaluations, we have seen an increase in comfort in this skill for residents and students, better identification of learners who have difficulty with related competencies, and a more efficient hand-over process. Given that students believe resident role-modeling is the main method hand-over skills are learned, emphasis on how residents role-model hand-overs will be important.