Implementing Standardization into Patient Handoffs in Radiation Oncology Residency

Abstract

<h3>Purpose/Objective(s)</h3> Patient handoff is vital for quality care and smooth transition of patient information between practitioners. Poorly executed handoffs can result in critical and potentially life-threatening patient care errors. Well-designed patient handoff workflows have demonstrated reduced patient errors and reduced stress for patient care teams. The radiation oncology patient workflow includes a complex diagram of multiple handoffs from the initial consult to the completion of treatment. Resident physicians play a key role in updating patient status designations and as such, because of clinical rotation transitions as part of the learning experience, a critical handoff with a high volume of patient information occurs every three months. This quality improvement project focused on the use of a standardized patient handoff format in our department. We hypothesized that the creation of a standardized process would improve the overall patient handoff experience for resident physicians. <h3>Materials/Methods</h3> Using a dedicated Radiation Oncology EMR we developed a standardized patient handoff process that included key timeline designations (KTD) from the initial consult to completion of treatment. Each patient had a designated area where the KTD was updated by the resident physicians. KTD included: pending decision, pending results, pending neoadjuvant care, pending surgery, pending sim, pending contours, pending plan, pending treatment scheduling, on treatment, pending follow up. Resident physicians utilized the EMR with KTD indicators as the source for patient handoffs during clinical rotation transitions. Following the transition, a brief survey was sent to the residents to assess the need for patient handoff, the effectiveness of the new handoff system, and general ideas on what works with the new handoff system, as well as suggested areas of improvement. <h3>Results</h3> A total of 6 surveys was sent out with a 100% response rate. Survey results revealed, 83% of residents felt handoffs were important for consults, 83% felt they were important for simulated patients, and 66% placed importance on handoff for "on-treatment" patients. The majority, 83%, preferred a centralized hand off area. Regarding the old handoff system, 33% were satisfied, 33% were neutral, and 33% were dissatisfied. With the new system, residents reported 40% satisfaction and 60% neutral. <h3>Conclusion</h3> The results of this project showed an improvement in the handoff system in comparison to the previous system while raising resident physician satisfaction during service transitions. Residents agreed patient handoffs at many different points of treatment planning are important, and the utilization of a centralized location for patient handoffs resulted in improved satisfaction. Future studies will evaluate the utilization of this centralized process's ability to reduce patient errors.