Kris H. Saudek,Medical College of Wisconsin,Milwaukee,WI,Robert W. Treat,Medical College of Wisconsin,Milwaukee,WI
Background: Gaps in healthcare communication have been cited as the leading cause of sentinel events in hospitals. Mandated limits on resident hours have increased breaks in continuity-of-care which is bridged with “sign-out.” There is insufficient data in the literature that medical students are being instructed and assessed on how to participate in a patient hand-off. The purpose of this study is to evaluate a previously described hand-off mnemonic with M3 medical students during their pediatric clerkship.
Methods: All students were expected to use SAFETIPS when signing-out on inpatient wards. Students were randomly assigned to a curriculum or control group, and completed patient hand-off confidence pre-surveys. The curriculum group participated in a workshop at the beginning of the clerkship teaching hand-offs using SAFETIPS. Faculty members assessed student hand-offs at the end-of-clerkship, followed by a student post-survey.
The SAFETIPS Patient Hand-off Inventory had eight inventory scores measured with a three-point Likert-scale (0pts=lowest/2pts=highest). Seven survey items were measured with a five-point Likert-scale (5=extremely confident). Mann-Whitney U-tests and independent t-tests determined statistically significant differences between student groups (curriculum vs. control) for items in the inventory and pre/post surveys. Inter-item reliabilities were reported as Cronbach alpha. Statistical analyses were generated with IBM® SPSS® 21.0.
Results: The statistically significant difference (p=.001) in mean inventory scores (alpha=.70) for students in the curriculum (12.8(±1.6)) vs. control (11.2(±2.8)) is coupled to a large effect size (Cohen’s d=0.67). Five SAFETIPS items reported significant increases (p≤.050) for students in the curriculum vs. control. Significant increases in overall pre/post survey (alpha=.90) median scores are reported for students in the curriculum (pre/post difference=1.3,p=.001) and in the control group (difference=1.0, p=.001) for the survey. The largest increases for both groups was “using SAFETIPS to give/listen to hand-off of patients” (difference=2.0,p=.001).
Discussion: M3 skill and confidence level giving hand-offs using SAFETIPS is improved with the use of a formal curriculum. Patient hand-off is a critical skill to develop; early introduction into the curriculum should provide earlier competency. This improvement in medical hand-off has the potential to decrease the number of medical errors related to communication.