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ALERT PRESENTATION: IMPROVING THE QUALITY
 OF EMERGENT HAND-OFFS USING SIMULATED
  CRITICAL PATIENT EVENTS AND SIMULATED
    STRUCTURED EMERGENT HAND-OFFS

     INSPIRE MEETING, IMSH JAN 28,2012



    Ashley Sens, Derek Callaway, Marcy Singleton, Heather Robertson,
                            Matthew Braga
BACKGROUND
• Patient hand-offs have been shown to be a portal for failures and medical
  errors
• Developing validated emergent hand-off score tool and emergent hand-off
  curriculum and demonstrate improved simulated patient hand-offs
    • Small pilot study to validate an ISBAR based hand-off scoring tool
      without inter-rater reliability
    • Ongoing revisions of scoring tool including “splitter” and “lumper”
      varieties
• Knowledge Gaps
    • Can we develop a general scoring tool for simulated patient handoffs
      that has inter-rater and intra-rater reliability?
    • Will a hand-off curriculum improve simulated patient hand-offs?
    • Can these results be translated to actual patient hand-offs?
PICO QUESTION
• Population
     Pediatric residents participating in simulated critical patient events, with
      team leader handing-off the patient at the end of the event.
• Intervention
     Emergent hand-off curriculum
• Comparison
     Pre and post curriculum
     Curriculum verses no curriculum
• Outcome
     Statistically significant improvement in hand-off as measured by scoring
      tool
APPROACH
• Prospective cohort study: cohort will be all pediatric residents at Dartmouth-
  Hitchcock Medical Center with the potential to expand the cohort to be multi-
  institutional
• Validation of a newly developed emergent hand-off score tool
• Develop and implement emergent hand-off curriculum using ISBAR format to
  residents and provide ongoing feedback at the end of each session
• Conduct critical event simulations followed by simulated emergent hand -offs
• Score emergent hand-offs using newly developed emergent hand-off tool for
  both pre- and post-exposure to emergent hand-off curriculum
3 QUESTIONS
1   Are others having their team leaders hand-off the patient at the end of a typical resident
    scenario? How is the hand-off portion evaluated and is feedback given on the patient
    hand-off?
2   What is the best approach to improved inter-rater and intra-rater reliability when
    developing an emergent hand-off score tool?
3   Do we need to develop a specific scripted scenario or can we validate a generalizable
    hand-off scoring tool?

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Alert hand off san diego jan 16

  • 1. ALERT PRESENTATION: IMPROVING THE QUALITY OF EMERGENT HAND-OFFS USING SIMULATED CRITICAL PATIENT EVENTS AND SIMULATED STRUCTURED EMERGENT HAND-OFFS INSPIRE MEETING, IMSH JAN 28,2012 Ashley Sens, Derek Callaway, Marcy Singleton, Heather Robertson, Matthew Braga
  • 2. BACKGROUND • Patient hand-offs have been shown to be a portal for failures and medical errors • Developing validated emergent hand-off score tool and emergent hand-off curriculum and demonstrate improved simulated patient hand-offs • Small pilot study to validate an ISBAR based hand-off scoring tool without inter-rater reliability • Ongoing revisions of scoring tool including “splitter” and “lumper” varieties • Knowledge Gaps • Can we develop a general scoring tool for simulated patient handoffs that has inter-rater and intra-rater reliability? • Will a hand-off curriculum improve simulated patient hand-offs? • Can these results be translated to actual patient hand-offs?
  • 3. PICO QUESTION • Population  Pediatric residents participating in simulated critical patient events, with team leader handing-off the patient at the end of the event. • Intervention  Emergent hand-off curriculum • Comparison  Pre and post curriculum  Curriculum verses no curriculum • Outcome  Statistically significant improvement in hand-off as measured by scoring tool
  • 4. APPROACH • Prospective cohort study: cohort will be all pediatric residents at Dartmouth- Hitchcock Medical Center with the potential to expand the cohort to be multi- institutional • Validation of a newly developed emergent hand-off score tool • Develop and implement emergent hand-off curriculum using ISBAR format to residents and provide ongoing feedback at the end of each session • Conduct critical event simulations followed by simulated emergent hand -offs • Score emergent hand-offs using newly developed emergent hand-off tool for both pre- and post-exposure to emergent hand-off curriculum
  • 5. 3 QUESTIONS 1 Are others having their team leaders hand-off the patient at the end of a typical resident scenario? How is the hand-off portion evaluated and is feedback given on the patient hand-off? 2 What is the best approach to improved inter-rater and intra-rater reliability when developing an emergent hand-off score tool? 3 Do we need to develop a specific scripted scenario or can we validate a generalizable hand-off scoring tool?