Developing a Standardized and Sustainable Resident Sign-Out Process: An AIAMC National Initiative IV Project

Duty hour restrictions imposed upon training physicians have led to increased handoffs and the potential for discontinuity in patient care. Research has demonstrated a significant opportunity for decreasing errors with a standardized handoff process. Thus, we designed a project to implement a standardized approach to handoffs, specifically resident-to-resident handoffs.

We performed an initial assessment of the tools, practices, and policies currently in use to facilitate handoffs institutionally. Subsequently, we created a template within our electronic medical record and paired it with a verbal handoff process. We developed a plan to build department champions to disseminate information and provide mentorship. We intend to evaluate this process at designated intervals to ensure sustainability.

Survey results were obtained from 45 faculty and 61 residents from a wide representation of specialties. We found that although a subjective sense of satisfaction was present, there was substantial variability between processes. Seventy-two percent of faculty reported at least once identifying a patient safety issue that occurred as a result of the handoff process, but 77% of faculty sometimes or never supervised the process. Eighty percent of residents reported sometimes or never receiving feedback on their handoffs.

Based on medicine's evolving environment and an apparent opportunity to optimize resident training and patient safety, we developed a plan to standardize, implement, and evaluate resident handoffs within our system. The results thus far have resulted in a gap analysis that will serve as the basis for reporting finalized data at the conclusion of this prospective study.