Board 277 - Program Innovations Abstract b-SAFER

Abstract

Introduction/Background Breakdowns in communication are the leading cause of sentinel events according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Arguably, patient handoffs, defined by the JCAHO as "the process of passing information from one person (or team) to another (along with authority and responsibility) for the purpose of ensuring continuity and safety of a patient’s care," are the most prevalent points of communication and information transfer in healthcare. Studies show that ineffective handoffs lead to delays in treatment, increased length of stay, severe adverse events and patient dissatisfaction.1 Additional studies suggest that strictly verbal handoffs result in nearly 100% data loss.2 In response to recognized gaps, JCAHO implemented National Safety Goal 2E, which required a "standardized approach to handoffs including the opportunity to ask and respond to questions. Despite Goal 2E, no uniform mechanism exists for delivering or teaching handoffs and they continue to present deficits in practice for adequate transfer of patient information. Methods As part of a semester-long Interprofessional Teamwork and Communication (IPT) Course, focused on patient safety and effective communication, we developed a module for teaching effective handoffs. The elective course is offered to medical, nursing and pharmacy students and focuses on medical error and effective communication using TeamSTEPPS. As part of the module, we included a unique handoff mnemonic, b-SAFER, to assist learners in organizing their thoughts and delivering efficient patient handoffs interprofessionally. For this module, learners began with a two station simulated series of handoffs in mock shift changes while handing off five patients, reviewed from paper-based vignettes, to a classmate. Students were permitted three minutes to review the patient vignettes and take notes before having five minutes to hand off to the next student. Students receiving the patients completed a brief checklist with questions about their new patients before rotating to a new room and handing off a new set of five patients that included a mix of progressed versions of the previous patients and new patients. The conveyed information was captured in the checklist and the loss of any information was shown statistically to the class to begin the 45-minute didactic lecture on patient handoffs, barriers to effective handoffs and to introduce b-SAFER as a model for safer handoffs. The mnemonic represents: brief Background, Situation, Active Issues, Future Plan, Ensuring Understanding, Repeat for Clarity. A small group breakout during the lecture provided opportunity for the students to practice additional handoffs using b-SAFER. Following the didactic session, students rotated again through another round of two simulated shift changes with a new set of patients. Results: Conclusion Although the data collected from the simulated shift changes was limited, it did provide an opportunity to recognize communication gaps from the first round of handoffs. From the second round of handoffs following the lecture and while using b-SAFER, students (N=17) improved (mean score 43% pre and 77% post) and provided more relevant information during the handoffs. There was also less data loss. The mnemonic b-SAFER is designed as a simpler format to deliver information on multiple patients more efficiently than other existing mnemonics. It showed to be very useful as a teaching and assessment tool and may prove useful as a template for real handoffs.