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Milestones to Teach and Evaluate Handoffs

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Milestones to Teach and Evaluate Handoffs

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