12 Dec Recommended Medical Handoff Strategies Remain Underutilized
MedicalResearch.com Interview with:
Dr. Charlie Wray
Charlie M. Wray, DO, MS
Assistant Clinical Professor of Medicine
University of California, San Francisco Department of Medicine
San Francisco VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Since the establishment of residency duty hour regulations in 2010, which subsequently lead to increased discontinuity of inpatient care and more resident shift work, educators and researchers have attempted to establish which shift handoff technique(s) or strategies work best.
National organizations, such as the ACGME, AHRQ, and the Joint Commission have made specific recommendations that are considered “best practice”. In our study, using an annual national survey given to Internal Medicine Program Directors, we examined the degree of implementation of these recommended handoff strategies and the proportion of Program Director satisfaction with each of the respective strategies.
MedicalResearch.com: What are the main findings?
Response: We found that while 61% of Program Directors reported being satisfied with their institutions strategies, a large degree of heterogeneity in implementation existed, with implementation rates of respective strategies ranging from 6-67%. Additionally, Program Directors reported being most satisfied with the following strategies: Having a dedicated room, supervision by a senior resident, using an EHR-enabled handoff, and the receiver getting a written copy of the sign-out. And finally, we noted that there was a large degree of discordance between implementation rates and Program Director satisfaction (i.e. highly implemented were not always associated with Program Director satisfaction).
MedicalResearch.com: What should readers take away from your report?
Response: Despite the emphasis and large amount of research placed on shift handoff strategies over the past several years, there remains an under utilization of recommended handoff strategies. Additionally, the discordance between implementation rates and Program Director satisfaction may suggest confusion regarding which practices or combination of practices is best for their setting and patient population.
Finally, our study may also suggest that despite program directors desire or willingness to implement such strategies, they may face barriers to implementation; such as a lack of resources, training, or local expertise.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: While our study was based off of the 2014 annual APDIM survey, in that same year the iPASS study, the first prospective, multi-center study that examined a multifaceted bundled handoff program that showed substantial improvements in medical errors and preventable adverse events was published. Many of the techniques that were recommended and studied in our analysis were utilized within this study. It will be interesting to see how the success of this program infiltrates programs on a national level, and whether we see a shift in implementation rates because of these findings. Additionally, many will be looking to see if other handoff bundles/combinations can have similar effects.
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Last Updated on December 12, 2016 by Marie Benz MD FAAD