Abstract
BackgroundHandoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents’ perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs.MethodsA qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts.ResultsAlthough some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients.ConclusionsResidents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.
Highlights
Handoff education is both formal and informal and varies widely across medical school and residency training programs
Training for end-of-shift handoff competency is infrequently included in formal medical education and, where it is, the content and structure of the training varies widely [11]
Our findings indicate that critical skills for enacting effective patient handoffs were mostly learned informally through observation and experience
Summary
Handoff education is both formal and informal and varies widely across medical school and residency training programs. End-of-shift patient handoffs, known as transfersof-care or sign-outs, pose a substantial patient safety risk and an opportunity for quality improvement. These transitions lead to unwanted variation in handoffs and have been associated with delays in diagnosis and treatments [1], duplication of tests or treatment and patient discomfort [2], inappropriate care and less functional training for health care personnel [3], medication errors and failure to follow a patient’s code status [4], and longer hospital stays and increased laboratory testing [5, 6]. The clash between formal training and local practice culture (i.e., “the way things are done around here”) may contribute to the considerable variation observed in handoff effectiveness [13,14,15,16]
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