End-of-shift handoffs are complex interactions influenced by many factors, and changes need to be made to prepare medical residents to successfully execute the transitions.
That's the conclusion of a team of research scientists, who highlighted the challenges and provided guidance on creating a systematic approach to teaching and carrying out transfers of care.
Researchers from Regenstrief Institute, the Department of Veterans Affairs, Indiana University School of Nursing, Wayne State University School of Medicine and Applied Decision Science interviewed medical residents from three VA medical centers across the country to learn more about handoffs. They published three papers from their findings.
End-of-shift handoffs - when one resident takes over from another - pose a substantial patient safety risk. The transition of care from one doctor to another has been associated with delays in diagnosis and treatment, duplication of tests or treatment and patient discomfort, inappropriate care, medication errors and longer hospital stays with more laboratory testing.
With patients wielding greater power as consumers and federal penalties in place for not meeting certain quality standards, all of those factors have potentially negative reimbursement implications.
Handoff education varies widely in medical schools and residency training programs. There have been efforts to improve transfers of care, but they have not shown meaningful improvement.
In one paper, led by Laura Militello and published in The Joint Commission Journal of Quality and Patient Safety, researchers detailed the importance of cognitive preparation for the handoffs. They identified six cognitive tasks residents engaged in before the handoff.
These activities point to strategies for support via improved technology, organizational interventions and enhanced training. Those include a handoff tool that automatically populates key fields, creating a dedicated preparation time free from distractions and scenario-based simulation training.
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Another finding: Medical residents said they were only partially prepared for enacting handoffs as interns, and experience is actually what taught them the most. In the paper published in BMC Medical Education, the authors discussed how formal education is not enough to teach effective handoffs.
They offered recommendations to improve education, including: establishing collaborative learning meetings among medical students, interns and residents; providing point-of-care education programs connecting best practices with patient safety and efficacy goals; using stories to make handoff curricula salient for learners; and enacting actual handoffs.
The third paper, just published in the Journal of General Internal Medicine, explains how the person receiving the handoff can affect the interaction. Medical residents said they changed their delivery based on the doctor or resident who was taking over.
The paper concluded that interventions designed to improve patient handoffs should more explicitly account for the role of the handoff recipient and not overemphasize standardizing the procedure.
The findings come as an increasing number of residents are doing their training internationally. Because of a freeze on the number of residency slots that are available, the demand for international trainees has increased in recent years. Some states, such as Georgia and Florida, have begun funding their own residency programs to help stem effects from the physician shortage.