Using peers to assess handoffs: a pilot study

The Impact of Environmental Context on Intern Sign-Out Quality

BACKGROUND

Resident duty-hour restrictions have led to more sign-out transitions, increasing the potential for preventable harm. An unfavorable environment is expected to exacerbate sign-out risks to patient safety.

OBJECTIVE

The aim of the study was to evaluate the impact of noise, interruptions, long sign-outs, and sign-outs exceeding allotted time on sign-out quality.

METHODS

Eight trained observers evaluated 620 evening patient sign-outs between interns for 40 weeknights between February and April 2015 at a large internal medicine training program. Quality of sign-out was measured three ways: information quality, scores from the Handoff CEX Tool, and peer evaluations.

RESULTS

Noise had no impact on information quality. Interruptions negatively affected information quality (-0.10 < r < -0.15, P < 0.001) and Handoff CEX quality scores (-0.11 < r < -0.26, P < 0.001). Long sign-outs taking more than 1 hour negatively affected sign-out quality (-0.09 < r < -0.23, P < 0.05). Sign-outs exceeding allotted time negatively impacted peer evaluations (-0.11 < r < -0.22, P < 0.001).

CONCLUSIONS

Interruptions, long sign-outs, and sign-outs exceeding allotted time were related to lower sign-out quality. Improving the environment to reduce interruptions and training interns to manage their time during sign-outs may improve sign-out quality.

Feedback and Assessment Tools for Handoffs: A Systematic Review

BACKGROUND

Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs.

OBJECTIVE

We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools.

METHODS

The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system.

RESULTS

A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters.

CONCLUSIONS

A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.