Academic journal article International Journal of Child and Adolescent Health

Assessing the Impact of a Web Based Educational Intervention on the Patient Handoff Process among Pediatric Residents: A Pre and Post Test Evaluation

Academic journal article International Journal of Child and Adolescent Health

Assessing the Impact of a Web Based Educational Intervention on the Patient Handoff Process among Pediatric Residents: A Pre and Post Test Evaluation

Article excerpt

Introduction

Patient handoffs are the transfer of accountability and responsibility for a patient from one provider to another.

Successful handoffs ensure a shared mental model of the patient, expected trajectory and anticipatory guidance for potential changes in clinical status. Recent changes in health care delivery, including limits on resident duty hours (1), have increased the number of handoffs.

Future changes to the delivery system, including new and more stringent Accreditation Council on Graduate Medical Education mandated limits on resident duty hours (2) and increased specialization of the physician workforce, will make handoffs even more common. Currently, communication among providers is inadequate (3-5) and handoffs are problematic (6-8). Among house staff, prior studies demonstrate both increased errors attributed to discontinuity of care and adverse outcomes associated with problems with handoffs (9-12).

At one major teaching hospital, fifty-nine percent of residents reported that one or more patients had been harmed during their most recent clinical rotation because of problematic handoffs (13). Further, researchers have shown that residents overestimate the effectiveness of their handoff communication (14). Thus, adequate communication is essential for patient safety, yet it is an underdeveloped skill among providers.

The Joint Commission National Patient Safety Goals include implementing a standardized approach to handoff communication (15) but few residency programs have standardized curricula dedicated to the handoff process (16) and little evidence exists suggesting a best practice (17-19). Further, little is known about the attitudes and practice of pediatric residents regarding the handoff process and about how to improve these domains in an efficient manner.

This information is necessary for pediatric residency programs as they develop and implement high impact interventions that create a sustainable standardized handoff process.

The objective of this study was to describe the attitudes and practices of residents regarding the patient handoff process and to assess how these attitudes and practices are impacted by a web based educational module that promotes a standardized handoff tool.

Methods

Educational intervention and handoff tool

Pediatric residents at a large, urban, free standing, academic children's hospital were asked to participate in a web based educational workshop via the Chex Web Exchange (Child Health Corporation of America, Shawnee Mission, KS), an online learning venue for hospital staff. This educational intervention was considered part of a hospital wide effort to standardize the handoff process which also included the hospitalist division. The content of this educational module was developed by the authors.

The educational module was designed to impact the attitudes and practice of pediatric residents in regards to the patient handoff process. The first part of the module focused on changing the residents' attitudes. The module used real examples to illustrate the consequences of poor patient handoffs.

It reviewed the Joint Commission National Patient Safety Goals and emphasized our institution's commitment to improving the patient handoff process. The second part of the module was directed at the residents' practice. The module introduced a standardized handoff tool known as the 6Ps (patient, problem, progress, plan, purpose, precautions) (20).

This tool was modified from the original 5 Ps tool developed by Sentara Health Care (Norfolk, Va.) and is intended as a method to organize the patient handoff process rather than dictate the content. The educational module explained the 6Ps handoff tool and then required residents to prepare a mock patient handoff using it. The educational module was followed by a brief exam.

Residents were invited to participate via an email announcement. Participating residents completed an online module between January and May 2010. …

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