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Riesenberg LA, Davis JJ, Kaplan E, Ernstberger GC, O'Hagan EC. Handoff Education Interventions: A Scoping Review Focused on Sustaining Improvements. Am J Med Qual 2024; 39:229-243. [PMID: 39268906 DOI: 10.1097/jmq.0000000000000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006-June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%-68%) and a smaller but important increase in reporting patient outcomes (11%-18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), P = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.
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Affiliation(s)
- Lee Ann Riesenberg
- Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Elle Kaplan
- Department of Anesthesiology, Brown University, Providence, RI
| | | | - Emma C O'Hagan
- Lister Hill Library at University Hospital (UAB Libraries), University of Alabama at Birmingham, Birmingham, AL
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Trehan R, Chen C, Bhalla R. Peer review for handoff education in a transition to residency course: A prospective cohort study. Health Sci Rep 2024; 7:e2292. [PMID: 39118671 PMCID: PMC11306289 DOI: 10.1002/hsr2.2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 07/11/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
Background and Aims Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) mandate training in handoff delivery for students and residents. Communication errors, including errors during handoffs of patient care, account for over 2/3 of sentinel events. This study aims to assess the effectiveness of peer-assisted learning (PAL) in handoff education within a longitudinal framework. Methods This study involved the analysis of fourth-year medical students (n = 67) enrolled in a transition to residency program designed to reinforce skills essential for success in internal medicine residencies. We modified the I-PASS handoff rubric for a single-encounter evaluation. Before attending the transitions of care workshop, students submitted one written handoff report. During high-fidelity simulation sessions, peers evaluated the written document as well as verbal handoffs, while faculty evaluated a recorded verbal version. The primary outcome measured was improvement in handoff quality and accuracy over time and secondary outcomes compared peer- and self-evaluations to faculty assessments. Results Overall, students demonstrated a statistically significant improvement in handoff quality and accuracy across all scoring criteria after completing the peer evaluation process. Peer evaluations did not demonstrate statistically significant differences in scores for quality or accuracy questions as compared to faculty. Conclusion Peer evaluators effectively assessed handoff reports using the modified I-PASS checklist yielding outcomes similar to faculty while providing feedback. These findings provide exciting evidence that should prompt training programs to consider incorporating standardized peer review into handoff education for medical students and, potentially, residents. The detailed evaluation of individual handoff events fosters feedback skills essential for ongoing professional growth and clinical excellence.
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Affiliation(s)
- Rajiv Trehan
- Robert Wood Johnson Medical SchoolRutgers UniversityPiscatawayNew JerseyUSA
| | - Catherine Chen
- Department of Medicine, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Raman Bhalla
- Department of Medicine, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
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Klocko DJ. Using structured communication to improve patient handoffs and reduce medical errors. JAAPA 2024; 37:42-44. [PMID: 38985115 DOI: 10.1097/01.jaa.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
ABSTRACT Communication errors during transfer of care from one clinician to another are a major cause of medical errors. In 2006, The Joint Commission made handoff communications a national patient safety goal. In 2014, the Association of American Medical Colleges included giving and receiving a report to transfer a patient's care as one of the 13 core entrustable professional activities required for entry into residency programs. Communication is the key to successful transfer of patient care from one clinician to another during shift change. A structured method of communication used by all clinicians in high-stakes healthcare settings can ensure all vital information about a patient is given to the receiving clinician.
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Affiliation(s)
- David J Klocko
- David J. Klocko is an associate professor in the PA program at the University of Texas Southwestern Medical Center in Dallas, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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Harrington JW, Cholis T, Colacchio K. Navigating quality and safety in your health system: understanding the alphabet soup. Curr Probl Pediatr Adolesc Health Care 2023; 53:101460. [PMID: 37993300 DOI: 10.1016/j.cppeds.2023.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Entering any new healthcare system today requires thorough knowledge about its quality and safety structure and culture. Learning that language is generally the first step in gaining a better understanding of how systems function. This overview of common mnemonics in the quality and safety world will provide the reader with better comprehension of their quality systems within their institutions. Healthcare providers should understand how patient safety organizations were established and the importance of our safety event classification system, along with the ability to recognize gaps in care that highlight opportunities for improvement. In addition, this review provides explanations of error prevention tools used every day to help new colleagues communicate better and share situational awareness to keep patients safe. Lastly, utilization of standard quality improvement tools can facilitate quality improvement projects and assist all healthcare systems to become highly reliable organizations.
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Affiliation(s)
- John W Harrington
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA.
| | - Tom Cholis
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Kathryn Colacchio
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
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Starmer AJ, Michael MM, Spector ND, Riesenberg LA. Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00130-7. [PMID: 37423813 DOI: 10.1016/j.jcjq.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events. CONCEPTUAL FRAMEWORK The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ. IMPLICATIONS Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.
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Keebler JR, Lynch I, Ngo F, Phelps E, Huang N, Guttman O, Preble R, Minhajuddin AT, Gamez N, Wanat-Hawthorne A, Landgraf K, Minnis E, Gisick L, McBroom M, Ambardekar A, Olson D, Greilich PE. Leveraging the Science of Teamwork to Sustain Handoff Improvements in Cardiovascular Surgery. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00120-4. [PMID: 37357132 DOI: 10.1016/j.jcjq.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Improving the reliability of handoffs and care transitions is an important goal for many health care organizations. Increasing evidence shows that human-centered design and improved teamwork can lead to sustainable care transition improvements and better patient outcomes. This study was conducted within a cardiovascular service line at an academic medical center that performs more than 600 surgical procedures annually. A handoff process previously implemented at the center was poorly adopted. This work aimed to improve cardiovascular handoffs by applying human factors and the science of teamwork. METHODS The study's quality improvement method used Plan-Do-Study-Act cycles and participatory design and ergonomics to develop, implement, and assess a new handoff process and bundle. Trained observers analyzed video-recorded and live handoffs to assess teamwork, leadership, communication, coordination, cooperation, and sustainability of unit-defined handoff best practices. The intervention included a teamwork-focused redesign process and handoff bundle with supporting cognitive aids and assessment metrics. RESULTS The study assessed 153 handoffs in multiple phases over 3 years (2016-2019). Quantitative and qualitative assessments of clinician (teamwork) and implementation outcomes were performed. Compared with the baseline, the observed handoffs demonstrated improved team leadership (p < 0.0001), communication (p < 0.0001), coordination (p = 0.0018), and cooperation (p = 0.007) following the deployment of the handoff bundle. Sustained improvements in fidelity to unit-defined handoff best practices continued 2.3 years post-deployment of the handoff bundle. CONCLUSION Participatory design and ergonomics, combined with implementation and safety science principles, can provide an evidence-based approach for sustaining complex sociotechnical change and making handoffs more reliable.
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Society for Maternal-Fetal Medicine Special Statement: Curriculum outline on patient safety and quality for maternal-fetal medicine fellows. Am J Obstet Gynecol 2023; 228:B2-B17. [PMID: 36738911 DOI: 10.1016/j.ajog.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To help fellows in maternal-fetal medicine gain a well-rounded education in patient safety and quality, we present a curriculum outline that addresses the requirements of the Accreditation Council for Graduate Medical Education and the American Board of Obstetrics and Gynecology. For each month of fellowship, the outline suggests brief video clips, readings, and activities. Emphasis is placed on helping fellows develop and complete a quality improvement project. If desired, the curriculum can be modified to fit program-specific needs and can be adapted for use with residents in obstetrics and gynecology.
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Starmer AJ, Spector ND, O’Toole JK, Bismilla Z, Calaman S, Campos ML, Coffey M, Destino LA, Everhart JL, Goldstein J, Graham DA, Hepps JH, Howell EE, Kuzma N, Maynard G, Melvin P, Patel SJ, Popa A, Rosenbluth G, Schnipper JL, Sectish TC, Srivastava R, West DC, Yu CE, Landrigan CP. Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. J Hosp Med 2023; 18:5-14. [PMID: 36326255 PMCID: PMC10964397 DOI: 10.1002/jhm.12979] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. OBJECTIVE To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. DESIGN Prospective Type 2 Hybrid effectiveness implementation study. SETTINGS AND PARTICIPANTS Residents from diverse specialties across 32 hospitals (12 community, 20 academic). INTERVENTION External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. MAIN OUTCOME AND MEASURES Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. RESULTS 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p < .05) and 17.5 to 9.3 minor events/person-year (p < .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p < .001, n = 4812) and written (10% vs. 74%, p < .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p < .001) and written (29% vs. 78%, p < .001) patient summaries, verbal (29% vs. 78%, p < .001) and written (24% vs. 73%, p < .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p < .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
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Affiliation(s)
- Amy J. Starmer
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy D. Spector
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer K. O’Toole
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zia Bismilla
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Calaman
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Maria-Lucia Campos
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maitreya Coffey
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lauren A. Destino
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jennifer L. Everhart
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jenna Goldstein
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Dionne A. Graham
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jennifer H. Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eric E. Howell
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas Kuzma
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Greg Maynard
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Patrice Melvin
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shilpa J. Patel
- Department of Pediatrics, Kapi’olani Medical Center for Women and Children/University of Hawai’i John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Alina Popa
- Department of Medicine, University of California Riverside, Riverside, California, USA
- Division of Hospital Medicine, University of California San Diego, San Diego, California, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, California, USA
| | - Jeffrey L. Schnipper
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore C. Sectish
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Daniel C. West
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clifton E. Yu
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher P. Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kim OT. Patient safety as a global health priority. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
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Reszel J, van den Hoek J, Nguyen T, Aravind G, Bayley MT, Bird ML, Edwards K, Eng JJ, Moore JL, Nelson MLA, Ploughman M, Richardson J, Salbach NM, Tang A, Graham ID. The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation. JMIR Form Res 2022; 6:e37189. [PMID: 35904870 PMCID: PMC9377478 DOI: 10.2196/37189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner’s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke.
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Affiliation(s)
- Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Tram Nguyen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kate Edwards
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Moore
- South Eastern Norway Regional Knowledge Translation Center, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN, United States
| | - Michelle L A Nelson
- March of Dimes Canada, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Reszel J, van den Hoek J, Nguyen T, Aravind G, Bayley MT, Bird ML, Edwards K, Eng JJ, Moore JL, Nelson MLA, Ploughman M, Richardson J, Salbach NM, Tang A, Graham ID. How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study. JMIR Form Res 2022; 6:e37243. [PMID: 35904855 PMCID: PMC9377454 DOI: 10.2196/37243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. Objective The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants’ implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. Methods This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. Results We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. Conclusions The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.
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Affiliation(s)
- Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Tram Nguyen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, ON, Canada
| | - Kate Edwards
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, ON, Canada
| | - Jennifer L Moore
- South Eastern Norway Regional Knowledge Translation Center, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN, United States
| | - Michelle L A Nelson
- March of Dimes Canada, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Smith LS, Barkmeier-Kraemer JM. Conceptual Framework Behind the Development of a Level of Confidence Tool: The Pediatric Videofluoroscopic Swallow Study Value Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:689-704. [PMID: 35201847 DOI: 10.1044/2021_ajslp-20-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The videofluoroscopic swallow study (VFSS) is the most commonly used instrumental procedure for evaluating swallowing in pediatric populations suspected of having dysphagia. Assessment and interpretation of a VFSS in pediatric populations is frequently challenged by testing-specific factors that can raise concerns regarding the representativeness of swallow events observed during testing compared to daily feeding/swallowing physiology. When VFSS findings do not represent typical swallowing patterns, treatment recommendations can result in suboptimal outcomes. To address this current challenge to pediatric VFSS interpretation and associated treatment recommendations, the pediatric VFSS Value Scale (pVFSS Value Scale) was developed within a tertiary regional pediatric medical center. This clinical focus article summarizes the initial scale development phases and resulting conceptual framework for rating clinical testing factors that influence a clinician's level of confidence regarding pediatric VFSS findings. Future goals for scientific evaluation and clinical utilization of this new rating scale are also reported. CONCLUSIONS The pVFSS Value Scale was developed to assist clinicians with interpretation of pediatric VFSS assessment outcomes and to efficiently communicate factors influencing impressions and treatment recommendations with team members and caregivers. This clinical concept article summarizes potential uses of this tool to inform treatment planning as well as future clinical research to evaluate its psychometrics and clinical utility.
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Affiliation(s)
- Leann Schow Smith
- Department of Rehabilitation, Primary Children's Hospital, Salt Lake City, UT
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Schmidt RF, Vibbert MD, Vernick CA, Mendelson AM, Harley C, Labella G, Houser J, Becher P, Simko E, Jabbour PM, Tjoumakaris SI, Gooch MR, Sharan AD, Farrell CJ, Harrop JS, Rosenwasser RH, Jaffe RC, Jallo J. Standardizing postoperative handoffs using the evidence-based IPASS framework through a multidisciplinary initiative improves handoff communication for neurosurgical patients in the neuro-intensive care unit. J Clin Neurosci 2021; 92:67-74. [PMID: 34509265 DOI: 10.1016/j.jocn.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
Errors in communication are a major source of preventable medical errors. Neurosurgical patients frequently present to the neuro-intensive care unit (NICU) postoperatively, where handoffs occur to coordinate care within a large multidisciplinary team. A multidisciplinary working group at our institution started an initiative to improve postoperative neurosurgical handoffs using validated quality improvement methodology. Baseline handoff practices were evaluated through staff surveys and serial observations. A formalized handoff protocol was implemented using the evidence based IPASS format (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, Synthesis by receiver). Cycles of objective observations and surveys were employed to track practice improvements and guide iterative process changes over one year. Surveys demonstrated improved perceptions of handoffs as organized (17.1% vs 69.7%, p < 0.001), efficient (27.0% vs. 72.7%, p < 0.001), comprehensive (17.1% vs. 66.7%, p < 0.001), and safe (18.0% vs. 66.7%, p < 0.001), noting improved teamwork (31.5% vs. 69.7%, p < 0.001). Direct observations demonstrated improved communication of airway concerns (47.1% observed vs. 92.3% observed, p < 0.001), hemodynamic concerns (70.6% vs. 97.1%, p = 0.001), intraoperative events (52.9% vs. 100%, p < 0.001), neurological examination (76.5% vs. 100%, p < 0.001), vital sign goals (70.6% vs. 100%, p < 0.001), and required postoperative studies (76.5% vs. 100%, p < 0.001). Receiving teams demonstrating improved rates of summarization (47.1% vs. 94.2%, p = 0.005) and asking questions (76.5% vs 98.1%, p = 0.004). The mean handoff time during long-term follow-up was 4.4 min (95% confidence interval = 3.9-5.0 min). Standardization of handoff practices yields improvements in communication practices for postoperative neurosurgical patients.
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Affiliation(s)
- Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Matthew D Vibbert
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Coleen A Vernick
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrew M Mendelson
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Caitlin Harley
- Department of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Giuliana Labella
- Department of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jessica Houser
- Department of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Patrick Becher
- Department of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Erin Simko
- Department of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rebecca C Jaffe
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jack Jallo
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
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14
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Shahian D. I-PASS handover system: a decade of evidence demands action. BMJ Qual Saf 2021; 30:769-774. [PMID: 33893212 DOI: 10.1136/bmjqs-2021-013314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David Shahian
- Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, USA
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O'Toole JK, Hepps J, Starmer AJ, Patel SJ, Rosenbluth G, Calaman S, Campos ML, Lopreiato JO, Schnipper JL, Sectish TC, Srivastava R, West DC, Landrigan CP, Spector ND, Yu CE. I-PASS Mentored Implementation Handoff Curriculum: Frontline Provider Training Materials. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10912. [PMID: 32715086 PMCID: PMC7375701 DOI: 10.15766/mep_2374-8265.10912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/01/2019] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training. METHODS The I-PASS Mentored Implementation Handoff Curriculum frontline provider training materials were created as part of the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach with an emphasis on adult learning theory principles. The training includes an overview of I-PASS handoff techniques, TeamSTEPPS team communication strategies, verbal handoff simulation scenarios, and a printed handoff document exercise. RESULTS As part of the SHM I-PASS Mentored Implementation Program, 2,735 frontline providers were trained at 32 study sites (16 adult and 16 pediatric) across North America. At the end of their training, 1,762 frontline providers completed the workshop evaluation form (64% response rate). After receiving the training, over 90% agreed/strongly agreed that they were able to distinguish a good- from a poor-quality handoff, articulate the elements of the I-PASS mnemonic, construct a high-quality patient summary, advocate for an appropriate environment for handoffs, and participate in handoff simulations. Universally, the training provided them with knowledge and skills relevant to their patient care activities. DISCUSSION The I-PASS frontline training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.
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Affiliation(s)
- Jennifer K. O'Toole
- Program Director, Internal Medicine-Pediatrics Residency Program, University of Cincinnati College of Medicine; Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; Associate Professor, Department of Internal Medicine, University of Cincinnati College of Medicine
- Corresponding author:
| | - Jennifer Hepps
- Program Director, National Capital Consortium Transitional Year Internship, Walter Reed National Military Medical Center; Associate Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Amy J. Starmer
- Director of Primary Care Quality Improvement, Boston Children's Hospital; Assistant Professor, Department of Pediatrics, Harvard Medical School
| | - Shilpa J. Patel
- Associate Professor, Department of Pediatrics, University of Hawaii John A. Burns School of Medicine; Pediatric Hospitalist, Kapi'olani Medical Center for Women & Children
| | - Glenn Rosenbluth
- Associate Director, Pediatric Residency Program, Benioff Children's Hospital; Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Sharon Calaman
- Program Director, Pediatric Residency Program, St. Christopher's Hospital for Children; Professor, Department of Pediatrics, Drexel University College of Medicine
| | - Maria-Lucia Campos
- Research Study Coordinator, Division of General Pediatrics, Boston Children's Hospital
| | - Joseph O. Lopreiato
- Associate Dean, Simulation Education, Uniformed Services University of the Health Sciences; Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Jeffrey L. Schnipper
- Associate Professor, Department of Medicine, Harvard Medical School; Associate Professor, Department of Medicine, Brigham and Women's Hospital
| | - Theodore C. Sectish
- Program Director, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Vice Chair for Education, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Professor, Department of Pediatrics, Harvard Medical School
| | - Rajendu Srivastava
- Assistant Vice President of Research, Intermountain Healthcare; Tenured Professor, Department of Pediatrics, Intermountain Primary Children's Hospital; Tenured Professor, Department of Pediatrics, University of Utah School of Medicine
| | - Daniel C. West
- Associate Chair for Education, Children's Hospital of Philadelphia; Professor, Department of Pediatrics, University of Pennsylvania School of Medicine
| | - Christopher P. Landrigan
- Chief, Division of General Pediatrics, Boston Children's Hospital; Director, Sleep and Patient Safety Program, Brigham and Women's Hospital; William Berenberg Professor of Pediatrics, Harvard Medical School
| | - Nancy D. Spector
- Executive Director, Executive Leadership in Academic Medicine Program, Drexel University College of Medicine; Associate Dean for Faculty Development, Drexel University College of Medicine; Professor, Department of Pediatrics, Drexel University College of Medicine
| | - Clifton E. Yu
- Deputy Director, Education, Training, and Research, Walter Reed National Military Medical Center; Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
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Handoff Communication between Remote Healthcare Facilities. Pediatr Qual Saf 2020; 5:e269. [PMID: 32426635 PMCID: PMC7190255 DOI: 10.1097/pq9.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/10/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Handoffs and transitions of care are common weak points in healthcare provider communication as patients move between sites. With no consistent pattern of communication between St. Jude Children’s Research Hospital (St. Jude) and its affiliated clinics, the Affiliate Program Office at St. Jude developed and implemented a standardized communication tool to facilitate patient transitions between different healthcare sites. Methods: Each team of providers created flow diagrams to define the current state of communication when patients were transitioning between remote sites. Fishbone diagrams identified the common barriers to effective communication as a lack of consistent communication and ownership. We developed a communication tool to address these barriers, which was disseminated by secure email. We measured the percent usage of the completed hand-off tool before a patient transitioned, staff experience, and the number of errors. Results: The time to send or receive the communication bundle was <10 minutes. Within 3 months of implementing the SMART bundle at 3 pilot sites, the bundle was used completely in 6 of 8 patient transitions and was associated with somewhat improved staff satisfaction. We identified no adverse events related to the communication bundle. Conclusions: In this small pilot study, we accomplished closed-loop communication between geographically remote healthcare sites by using an electronically transmitted standardized communication bundle.
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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