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Milestones to Teach and Evaluate Handoffs
 

Milestones to Teach and Evaluate Handoffs

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    Milestones to Teach and Evaluate Handoffs Milestones to Teach and Evaluate Handoffs Presentation Transcript

    • Milestones to Teach and Evaluate Handoffs Vineet M. Arora MD MAPP, Jeanne M. Farnan MD MHPE, Holly J. Humphrey MD University of Chicago, Pritzker School of Medicine Background Methods Conclusion
      • Funding: AHRQ 1R03HS018278-01 &
      • Department of Medicine Medical Education
      • and Clinical Excellence Award
      • Needs assessment for clinical exposure & participation in handoffs
      • Milestones for handoff education & evaluation developed
        • reviewed by external experts for content validity
        • Using handoff milestones, it is possible to develop and implement handoff teaching and evaluation across learner levels from medical student to faculty
      • Disseminate findings via national meetings, publications, speaking & web platforms
      • MergeLab on YouTube
      • [email_address]
      Next Steps
      • Objective: To develop and implement handoff teaching and evaluation that address milestones in handoff education from medical student to faculty
      • MS3 trained on how to turn H&P into written signout & HIPAA
      • New MS4 taught how to verbally signout before subinternship
      • Using case-based workshops & simulation, graduating MS4 & incoming interns practice giving & receiving handoffs
      • University of Chicago’s vertically integrated undergraduate & graduate medical education structure
        • development & implementation of education & evaluation across continuum of medical training
      Learner should be able to perform… Teaching Tools Learner should be able to know… Evaluation
      • Education & evaluation tools created along milestones
      • Implementation via working with med school & residency curriculum committees
      Graduating MS4 practice sending and receiving handoffs in case-based workshop as part of ‘Capstone Course’ Incoming intern reviews H&P and watches interval events video as part of Observed Simulated Handoff Exercise
      • Concerns voiced over handoffs after 2003 ACGME duty hour limits
      • 2008 – IOM recommends all residents receive handoff education
      • Tools to teach & evaluate handoffs lacking
      • Residents receive training in supervising & evaluating handoffs
      • Faculty development in how to incorporate handoff teaching into daily rounds is ongoing
      Competency-based peer evaluation Handoff CEX tool for observation Results Acknowledgments Julie Johnson, PhD, Leora Horwitz, MD Attending Resident Middle to late intern Early to middle intern 4 th year student/ incoming intern 3 rd year student
      • Census audit
      • Signout as part of plan
      • Handoff CEX
      • Review anticipatory guidance on rounds
      • Supervise, evaluate & provide feedback on handoffs
      • Principles of effective handoff education
      • How to evaluate handoffs
      • Handoff CEX
      • Paper tear exercise
      • OSHE
      • Teach & model strategies for effective handoffs
      • Supervise handoffs
      • Evaluate & provide feedback on handoffs
      • Understand theories of communication
      • Evaluation and feedback in improving handoffs
      • Peer Evaluation
      • Teaching video with checklist
      • Process map tutorial
      • Identify systems issues preventing effective handoffs
      • Use process improvement to improve handoffs
      • Identify & reflect on handoff errors
      • Understand handoffs as a process
      • Recognize systems issues in handoff errors
      • Understand near misses and adverse events due to poor handoffs
      • Handoff CEX-Receiver
      • Audit cross-cover note
      • Sender/Receiver pocket card
      • XCover Cases
      • Receive verbal handoff for larger numbers of patients with no prior knowledge (i.e. night float)
      • Basic evaluation of cross-cover patients
      • Document and communicate overnight events
      • Know strategies for receiving a handoff
      • Clinical reasoning for common issues arising when cross-covering
      • Handoff CEX- Sender
      • Paper tear
      • Pocket card
      • Case–based exercise
      • Provide a complete handoff (written and verbal) using effective communication strategies on patients they admit
      • Understand function & common pitfalls of verbal handoffs
      • Know strategies for effective communication for verbal handoffs
      • Written signout checklist
      • Pocket Card
      • Mock chart to signout exercise
      • Assess written signouts to identify defects
      • Create written signout from admitting H&P
      • Update written signout information
      • Ensure HIPAA compliance
      • Understand the importance of handoffs as a cause of errors
      • Function & content of a written signout
      • Common problems in written sign-out