A Standardized Handoff Simulation Promotes Recovery From Auditory Distractions in Resident Physicians

Qualitative Study on Safe and Effective Handover Information during a Rapid Response Team Encounter

Introduction

A rapid response team (RRT) evaluates and manages patients at risk of clinical deterioration. There is limited literature on the structure of the rapid response encounter from the floor to the intensive care unit team. We aimed to define this encounter and examine provider experiences to elucidate what information healthcare staff need to safely manage patients during an RRT evaluation.

Methods

This phenomenological qualitative study included 6 focus groups (3 in-person and 3 virtually) organized by provider type (nurses, residents, fellows, attendings), which took place until thematic saturation was reached. Two authors inductively coded transcripts and used a quota sampling strategy to ensure that the focus groups represented key stakeholders. Transcripts were then analyzed to identify themes that providers believe influence the RRT's quality, efficacy, and efficiency and their ability to manage and treat the acutely decompensating pediatric patient on the floor.

Results

Transcript coding yielded 38 factors organized into 8 themes. These themes are a summary statement or recap, closed-loop communication, interpersonal communication, preparation, duration, emotional validation, contingency planning, and role definition.

Conclusions

The principal themes of utmost importance at our institution during an RRT encounter are preparation, a brief and concise handoff from the floor team, and a summary statement from the intensive care unit team with contingency planning at the end of the encounter. Our data suggest that some standardization may be beneficial during the handoff.

Noise and turn-taking impact postanesthesia care unit handoff efficiency

Background

Optimal handoffs are pivotal for patient safety, yet some of the underlying communication mechanisms which support effective handoffs remain to be understood. As handoffs are conversations between providers, understanding communication mechanisms is necessary to improve handoff protocol development. The objective of this study was to characterize communication variables influencing the efficiency of handoffs in the postanesthesia care unit.

Methods

We conducted a single-center, observational study of handoffs over a three-week period in June/July of 2017. We recorded 96 handoffs between the cardiac operating room and postanesthesia care unit. We defined and measured efficiency by dividing the count of unique, nonrepetitive pieces of information by duration of the handoff conversation. Furthermore, we calculated and measured two communication variables: turn-taking and noise. We utilized West and Zimmerman’s Syntactic Scale to analyze turn taking by segregating noise into three subcategories: environmental noise caused by equipment, environmental noise caused by staff, and third-party interruptions. Finally, we recorded and measured the frequency and duration of noise and turn-taking during the handoff events.

Results

Due to technical issues, we transcribed and analyzed a total of 85 observations. Providers passed an average of 31.68 unique pieces of information during each handoff with the average length being 1 min and 46 s. Overlaps was the most common type of turn-taking behavior. Activity noise was the most common type of noise. Activity noise took place an average of 3.64 times per handoff and lasted an average of 9.83 s. Turn-taking accounted for 15.6% of variance in handoff efficiency. Together, noise and turn-taking accounted for 25.2% of the variance in handoff efficiency.

Conclusion

Because turn-taking and noise account for over a quarter the variance in handoff efficiency, recommendations include providing quiet locations for handoffs to take place. Additionally, we recommend that receivers provide input in any handoff interventional studies as their involvement would decrease the need to interrupt or clarify information from the sender.