Improving Patient Handoffs and Transitions in Care Among Residents: A Chief Resident-Led Initiative.

Area of Science:

• Medical Education
• Patient Safety
• Pediatric Residency Training

Background:

• Effective patient handoffs are critical for pediatric resident continuity of care and patient safety.
• Communication breakdowns during handoffs can lead to clinical uncertainty and adverse events.
• Increased patient safety alerts prompted an investigation into pediatric resident handoff communication failures.

Purpose of the Study:

• To identify areas for improvement in pediatric resident handoff procedures.
• To implement strategies to enhance pediatric resident competence in patient handoffs.
• To assess pediatric residents' confidence levels and the effectiveness of interventions on handoff skills.

Main Methods:

• Direct observation of 38 inpatient handoff sessions involving 40 pediatric residents over six months.
• Utilized a handoff checklist and provided formative feedback, noting deficits and barriers.
• Developed and delivered targeted handoff workshops, assessing pre- and post-workshop confidence using Likert scales.

Main Results:

• Protocol failures were observed in 50% of handoffs, including information relay, patient prioritization, and contingency planning issues.
• Pre-workshop, 67% of residents felt "very" or "fairly confident"; post-workshop, 98% reported similar confidence levels (P<0.001).
• No further patient safety alerts related to communication breakdowns were reported after workshop implementation.

Conclusions:

• Targeted, chief resident-led workshops effectively addressed protocol failures in pediatric resident handoffs.
• Interventions significantly improved the effectiveness of patient handoffs and reduced communication-related patient safety events.
• The study demonstrated sustained improvements in pediatric residents' confidence and competence in performing handoffs.