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Fukui EM, Lyons PG, Harris E, McCune EK, Rojas JC, Santhosh L. Improving Communication in Intensive Care Unit to Ward Transitions: Protocol for Multisite National Implementation of the ICU-PAUSE Handoff Tool. JMIR Res Protoc 2023; 12:e40918. [PMID: 36745494 PMCID: PMC9941899 DOI: 10.2196/40918] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/13/2022] [Accepted: 01/04/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients. The period after transfer has been associated with adverse events and additional work for care teams related to miscommunication or omission of information. Standardized handoff processes have been found to reduce communication errors and adverse patient events in other clinical environments but are understudied at the ICU-ward interface. We previously developed an electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge. OBJECTIVE The aim of this study is to evaluate the implementation process of the ICU-PAUSE handoff tool across 10 academic medical centers, including the rate of adoption and acceptability, as perceived by clinical care teams. METHODS ICU-PAUSE will be implemented in the medical ICU across 10 academic hospitals, with each site customizing the tool to their institution's needs. Our mixed methods study will include a combination of a chart review, quantitative surveys, and qualitative interviews. After a 90-day implementation period, we will conduct a retrospective chart review to evaluate the rate of uptake of ICU-PAUSE. We will also conduct postimplementation surveys of providers to assess perceptions of the tool and its impact on the frequency of communication errors and adverse events during ICU-ward transfers. Lastly, we will conduct semistructured interviews of faculty stakeholders with subsequent thematic analysis with the goal of identifying benefits and barriers in implementing and using ICU-PAUSE. RESULTS ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at 6 of 10 participating sites. Our results will be published in 2023. CONCLUSIONS Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40918.
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Affiliation(s)
- Elle Mizuki Fukui
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Patrick G Lyons
- Division of Pulmonary and Critical Care Medicine, John T Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St Louis, MO, United States
- Healthcare Innovation Lab, BJC HealthCare, St Louis, MO, United States
| | - Emily Harris
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Emma K McCune
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Juan C Rojas
- Department of Internal Medicine, Rush University, Chicago, IL, United States
| | - Lekshmi Santhosh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Keebler JR, Lazzara E, Griggs A, Tannenbaum S, Fernandez R, Greilich P, Salas E. Holistic strategy for promoting effective handoffs. BMJ LEADER 2022:leader-2022-000639. [DOI: 10.1136/leader-2022-000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
BackgroundHandoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality.MethodsThis article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments.ResultsWe examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care).ConclusionWe propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals.
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Stenquist DS, Yeung CM, Szapary HJ, Rossi L, Chen AF, Harris MB. Sustained Improvement in Quality of Patient Handoffs After Orthopaedic Surgery I-PASS Intervention. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00002. [PMID: 36067218 PMCID: PMC9447790 DOI: 10.5435/jaaosglobal-d-22-00079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE The I-PASS tool has been shown to decrease medical errors in patient handoffs in nonorthopaedic surgery fields. We prospectively studied the implementation of a version of this handoff tool modified for orthopaedic surgery patients in an academic practice at two level I trauma centers. METHODS This was a prospective study of a multicenter handoff improvement program. Handoffs were evaluated preintervention and at 1, 6, 9, and 18 months postintervention for key data elements defined by I-PASS. Rates of adverse clinical outcomes were compared before and after the handoff intervention. RESULTS Seven hundred five electronic patient handoffs were analyzed. From preintervention to the 18-month time point, notable improvement was observed in 8 of 9 targeted quality elements. In Poisson regression analysis, adherence to the standardized handoff format was sustained at markedly improved levels throughout all postintervention time points. No statistically significant differences were observed between rates of 30-day readmission, 90-day readmission, urinary tract infection, pulmonary embolism/deep vein thrombosis, surgical site infection, or delirium before and after the intervention. CONCLUSION Introduction of an orthopaedic-specific I-PASS tool produced sustained adherence from a group of over 50 orthopaedic providers. Objective quality of handoffs improved markedly as defined by the I-PASS standard, and 86% of the providers supported the ongoing use of the tool. Despite the improvement in handoff quality, we were unable to demonstrate a notable change in measured clinical outcomes. Methods for the development and implementation of the orthopaedic-specific I-PASS tool are described. Orthopaedic residency programs should consider using a version of I-PASS to standardize care.
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Affiliation(s)
- Derek S Stenquist
- From the Harvard Combined Orthopaedic Residency Program, Boston, MA (Dr. Stenquist, Dr. Yeung); the Harvard Medical School, Boston, MA (Szapary); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Rossi, Dr. Harris); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Chen)
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Chung JYS, Li WHC, Cheung AT, Ho LLK, Chung JOK. Efficacy of a blended learning programme in enhancing the communication skill competence and self-efficacy of nursing students in conducting clinical handovers: a randomised controlled trial. BMC MEDICAL EDUCATION 2022; 22:275. [PMID: 35418214 PMCID: PMC9009000 DOI: 10.1186/s12909-022-03361-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A clinical handover is an essential nursing practice that ensures patient safety. However, most newly graduated nurses struggle to conduct clinical handovers as they lack sufficient communication skill competence and self-efficacy in this practice. This study aimed to examine the efficacy of a blended learning programme on the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. METHODS A randomised controlled design was used. A convenience sample of 96 final-year baccalaureate nursing students at a local university. Data were collected in 2020. Participants were randomly assigned to either an experimental group (n = 50) that received a blended learning programme with face-to-face training and an online module on handover practice, or a waitlist control group (n = 46) that received only face-to-face handover training during the study period and an online module immediately after the completion of data collection. The primary outcome was the communication skill competence and the secondary outcome was the self-efficacy of the participants in conducting clinical handovers. An analysis of covariance was used to examine the between-subjects effects on self-efficacy and communication skill competence in conducting clinical handovers after controlling for the significantly correlated variables. A paired sample t-test was used to determine the within-subjects effects on self-efficacy. RESULTS The participants in the experimental group had significantly higher communication skill competence (p < 0.001) than those in the waitlist control group. Although both groups showed a significant improvement in self-efficacy, the mean scores of the experimental group were higher than those of the waitlist control group (p < 0.001). CONCLUSIONS This study demonstrated the efficacy of a blended learning approach in improving the communication skill competence and self-efficacy of final-year nursing students in conducting clinical handovers. Nurse educators should incorporate a blended learning approach into the nursing curriculum to optimise the content of training programmes for teaching nursing students in conducting clinical handovers. TRIAL REGISTRATION The study protocol was registered in the Registration ClinicalTrials.gov ( NCT05150067 ; retrospective registration; date of registration 08/12/2021).
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Affiliation(s)
| | - William Ho Cheung Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building Sha Tin, Hong Kong, China
| | - Ankie Tan Cheung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building Sha Tin, Hong Kong, China
| | - Laurie Long Kwan Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 8/F, Esther Lee Building Sha Tin, Hong Kong, China
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Lim H, Raffel KE, Harrison JD, Kohlwes RJ, Dhaliwal G, Narayana S. Decisions in the Dark: An Educational Intervention to Promote Reflection and Feedback on Night Float Rotations. J Gen Intern Med 2020; 35:3363-3367. [PMID: 32875511 PMCID: PMC7661589 DOI: 10.1007/s11606-020-05913-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Night float rotations, where residents admit patients to the hospital, are opportunities for practice-based learning. However, night float residents receive little feedback on their diagnostic and management reasoning, which limits learning. AIM Improve night float residents' practice-based learning skills through feedback solicitation and chart review with guided reflection. SETTING/PARTICIPANTS Second- and third-year internal medicine residents on a 1-month night float rotation between January and August 2017. PROGRAM DESCRIPTION Residents performed chart review of a subset of patients they admitted during a night float rotation and completed reflection worksheets detailing patients' clinical courses. Residents solicited feedback regarding their initial management from day team attending physicians and senior residents. PROGRAM EVALUATION Sixty-eight of 82 (83%) eligible residents participated in this intervention. We evaluated 248 reflection worksheets using content analysis. Major themes that emerged from chart review included residents' identification of future clinical practice changes, evolution of differential diagnoses, recognition of clinical reasoning gaps, and evaluation of resident-provider interactions. DISCUSSION Structured reflection and feedback during night float rotations is an opportunity to improve practice-based learning through lessons on disease progression, clinical reasoning, and communication.
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Affiliation(s)
- Hana Lim
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Katie E Raffel
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - James D Harrison
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Jeffrey Kohlwes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sirisha Narayana
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
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Dharod A, Wells BJ, Lenoir K, Willeford WG, Milks MW, Atkinson HH. Holiday Discharges Are Associated with Higher 30-Day General Internal Medicine Hospital Readmissions at an Academic Medical Center. South Med J 2019; 112:338-343. [PMID: 31158889 DOI: 10.14423/smj.0000000000000989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Academic medical centers face unique challenges in educating physician trainees in effective discharge practices to prevent readmissions. Meanwhile, residents must handle high workloads coupled with frequent rotations to different services. This study aimed to determine whether daily service census, service turnover, time of discharge, and day of discharge increase the risk of 30-day readmission. METHODS All of the discharges from two academic general internal medicine teaching services between October 1, 2013 and September 30, 2014 were included in this observational data analysis. Variables were fit to a 30-day, all-cause readmission outcome using multiple logistic regression with inverse probability of treatment weighting and multiple imputations with chained equations. The following potential confounding variables were included in the model: health system utilization, demographics, laboratory values, and comorbidities. RESULTS Among 1935 total discharges, 258 patients (13.3%) were readmitted within 30 days of the index discharge. Turnover, service census, weekend discharge, and time of discharge were not significantly associated with the risk of readmission. Patients discharged during holiday periods had higher odds of readmission (odds ratio 2.56, 95% confidence interval 2.01-3.25), whereas patients discharged on an intern switch day had lower odds of readmission (odds ratio 0.33, 95% confidence interval 0.27-0.41). CONCLUSIONS Patients who are discharged during holiday periods are at a higher risk of readmission after adjusting for potential confounders. These results also suggest that discharge on an intern switch day had a protective effect on readmission. Further work is needed to examine whether these findings can be replicated, and, if confirmed, to determine to what extent these associations are causal.
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Affiliation(s)
- Ajay Dharod
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
| | - Brian J Wells
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
| | - Kristin Lenoir
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
| | - Wesley G Willeford
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
| | - Michael W Milks
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
| | - Hal H Atkinson
- From the Department of Internal Medicine, Section on General Internal Medicine, the Department of Biostatistics and Data Science, and the Department of Internal Medicine, Internal Medicine Residency and Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, the Department of Internal Medicine, Section on Infectious Diseases, University of Alabama, Birmingham, and the Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus
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Santhosh L, Lyons PG, Rojas JC, Ciesielski TM, Beach S, Farnan JM, Arora V. Characterising ICU-ward handoffs at three academic medical centres: process and perceptions. BMJ Qual Saf 2019; 28:627-634. [PMID: 30636201 DOI: 10.1136/bmjqs-2018-008328] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is limited literature about physician handoffs between the intensive care unit (ICU) and the ward, and best practices have not been described. These patients are uniquely vulnerable given their medical complexity, diagnostic uncertainty and reduced monitoring intensity. We aimed to characterise the structure, perceptions and processes of ICU-ward handoffs across three teaching hospitals using multimodal methods: by identifying the handoff components involved in communication failures and describing common processes of patient transfer. METHODS We conducted a study at three academic medical centres using two methods to characterise the structure, perceptions and processes of ICU-ward transfers: (1) an anonymous resident survey characterising handoff communication during ICU-ward transfer, and (2) comparison of process maps to identify similarities and differences between ICU-ward transfer processes across the three hospitals. RESULTS Of the 295 internal medicine residents approached, 175 (59%) completed the survey. 87% of the respondents recalled at least one adverse event related to communication failure during ICU-ward transfer. 95% agreed that a well-structured handoff template would improve ICU-ward transfer. Rehabilitation needs, intravenous access/hardware and risk assessments for readmission to the ICU were the most frequently omitted or incorrectly communicated components of handoff notes. More than 60% of the respondents reported that notes omitted or miscommunicated pending results, active subspecialty consultants, nutrition and intravenous fluids, antibiotics, and healthcare decision-maker information at least twice per month. Despite variable process across the three sites, all process maps demonstrated flaws and potential for harm in critical steps of the ICU-ward transition. CONCLUSION In this multisite study, despite significant process variation across sites, almost all resident physicians recalled an adverse event related to the ICU-ward handoff. Future work is needed to determine best practices for ICU-ward handoffs at academic medical centres.
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Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA
| | - Patrick G Lyons
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Juan C Rojas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Thomas M Ciesielski
- Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Shire Beach
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA
| | - Jeanne M Farnan
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Vineet Arora
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Donnelly S, Dinesh D, Dew K, Stubbe M. The handover room: a qualitative enquiry into the experience of morning clinical handover for acute medical teams. Intern Med J 2018; 49:607-614. [PMID: 30324670 DOI: 10.1111/imj.14142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective clinical handover has always been integral to delivering safe, high-quality care in medical wards. AIM As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research. METHODS Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio-recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection. RESULTS There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities. CONCLUSION This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time-sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability.
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Affiliation(s)
- Sinead Donnelly
- Wellington Hospital, University of Otago, Wellington, New Zealand
| | - Dorothy Dinesh
- Wellington Hospital, University of Otago, Wellington, New Zealand
| | - Kevin Dew
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care, General Practice University of Otago, Wellington, New Zealand
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Wolfe JD, Gardner JR, Beck WC, Taylor JR, Bhavaraju A, Davis B, Kimbrough MK, Robertson RD, Karim SA, Sexton KW. Morning report decreases length of stay in trauma patients. Trauma Surg Acute Care Open 2018; 3:e000185. [PMID: 30234164 PMCID: PMC6135446 DOI: 10.1136/tsaco-2018-000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/02/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Modern acute care surgery (ACS) programs depend on consistent patient hand-offs to facilitate care, as most programs have transitioned to shift-based coverage. We sought to determine the impact of implementing a morning report (MR) model on patient outcomes in the trauma service of a tertiary care center. Methods The University of Arkansas for Medical Sciences (UAMS) Division of ACS implemented MR in October 2015, which consists of the trauma day team, the emergency general surgery day team, and a combined night float team. This study queried the UAMS Trauma Registry and the Arkansas Clinical Data Repository for all patients meeting the National Trauma Data Bank inclusion criteria from January 1, 2011 to April 30, 2018. Bivariate frequency statistics and generalized linear model were run using STATA V.14.2 Results A total of 11 253 patients (pre-MR, n=6556; post-MR, n=4697) were analyzed in this study. The generalized linear model indicates that implementation of MR resulted in a significant decrease in length of stay (LOS) in trauma patients. Discussion This study describes an approach to improving patient outcomes in a trauma surgery service of a tertiary care center. The data show how an MR session can allow for patients to get out of the hospital faster; however, broader implications of these sessions have yet to be studied. Further work is needed to describe the decisions being made that allow for a decreased LOS, what dynamics exist between the attendings and the residents in these sessions, and if these sessions can show some of the same benefits in other surgical services. Level of evidence Level 4, Care Management.
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Affiliation(s)
- John D Wolfe
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - James R Gardner
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - William C Beck
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - John R Taylor
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Avi Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Ben Davis
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Mary Katherine Kimbrough
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Ronald D Robertson
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
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Capsule Commentary on Duong et al., Exploring Physician Perspectives of Residency Holdover Handoffs: a Qualitative Study to Understand an Increasingly Important Type of Handoff. J Gen Intern Med 2017; 32:682. [PMID: 28243879 PMCID: PMC5442022 DOI: 10.1007/s11606-017-4016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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