Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education.

Abstract

Handoffs are an integral component of patient care, and the number of handoffs has increased as a result of duty hours restrictions for resident physicians. A structured handoff curriculum improves accuracy and has been shown to decrease medical errors. A standardized approach across all specialties is lacking in the published literature. The authors discuss the development and implementation of an institution-wide handoff curriculum for incoming first-year residents. An Innovation in Graduate Medical Education committee, including faculty from multiple specialties, identified an educational deficiency in handoffs and selected this as the target for the educational innovation. Meetings were held to develop and implement an extensive handoff curriculum for incoming first-year residents. The designed curriculum included large- and small-group sessions, and a specialty-specific observed simulated handoff experience. The authors analyzed participants' pre- and postsurveys using descriptive statistics. One hundred and twenty-four participants attended the formalized handoff training day. Following training, residents recognized that dedicated time for verbal exchange, templates for accessing and recording information, interactive handoffs giving priority to ill patients, and highlighting action items were most important for effective handoff. Both undergraduate and graduate medical education curricula need to develop formalized training and methods to assess competencies in handoffs. Training incoming residents is a logical starting place, but programs should be systematically disseminated across all specialties, from residents to faculty, in order to be effectively integrated into the culture of an institution.