Using a Direct Observation Tool (TOC-CEX) to Standardize Transitions of Care by Residents at a Community Hospital

Area of Science:

• Medical Education
• Patient Safety
• Health Systems Management

Background:

• High-quality patient care transitions are essential for hospital patient safety.
• Few undergraduate medical curricula incorporate transition-of-care training.
• Previous evaluations showed low resident awareness and adoption of the SAIF-IR mnemonic at Ascension Providence Rochester Hospital (APRH).

Purpose of the Study:

• To assess the impact of the Transitions of Care-Clinical Evaluation Exercise (TOC-CEX) on resident awareness and adoption of the SAIF-IR mnemonic.
• To standardize transitions of care as a practice habit at APRH through direct observation.

Main Methods:

• The study involved implementing the TOC-CEX, a direct observation tool, for faculty to monitor resident use of the SAIF-IR mnemonic.
• The TOC-CEX was adopted by 3 primary care programs at APRH.
• Resident responses from internal surveys before and after TOC-CEX implementation were analyzed.

Main Results:

• Faculty use of the TOC-CEX significantly increased resident awareness and adoption of the SAIF-IR mnemonic.
• A significant rise was observed in residents reporting their program had a mechanism for monitoring handoffs (P<0.0001).
• There was a significant increase in residents identifying the SAIF-IR mnemonic for verbal handoffs (P<0.0001).

Conclusions:

• The TOC-CEX is an effective tool for improving awareness and adoption of standardized handoff mnemonics in clinical learning environments.
• The TOC-CEX was found to be feasible and well-accepted by residents, faculty, and hospital leadership.
• The TOC-CEX became an integral part of the hospital's culture, perceived as vital for quality patient care.