BONNIE C. DESSELLE, MD PROGRAM DIRECTOR LSUHSC PEDIATRIC RESIDENCY PROGRAM Strategies and Tools to Enhance Communication Among Health Care Providers
Communication Series Part 1: Hand – offs Part 2: Formal Presentations Part 3: Communication during Emergencies
Hand - Offs Mechanism of transferring information, responsibility and/or authority from one set of care-givers to another
Sentinel Events
Root Causes of Sentinel Events ( ) -The Joint Commission of Accreditation of Hospitals
Call to Improve Handoffs Joint Commission, 2006 National Patient Safety Goal World Health Organization, 2006 Prevention of handover errors part of “High Fives” patient safety solutions Institute of Medicine, 2008 Teaching programs “should train residents in how to hand over their patients using effective communication.” ACGME, 2010 Programs must ensure and monitor effective, structured hand-over processes Must ensure that residents are competent in the hand-over process
Group Discussion Characteristics of Worst and Best Sign-offs
Group Discussion Live demonstrations of sign-offs
Essential Elements for Pediatric Sign-out List Demographics Name MRN Unit/room number Age Weight Gender Allergies Admit date Attending physician/Service/Consults Phone numbers and covering physician History and Problem List Primary diagnosis(es) Chronic problems (pertinent to this admission/shift) Current condition/status
Essential Elements for Pediatric Sign-out List System based Pertinent Medications and Treatments Oral and IV medications IV fluids Blood products Oxygen Respiratory therapy interventions Pertinent lab data To do list Check x-ray, labs, wean treatments Include rationale
Essential Elements for Pediatric Sign-out List Contingency Planning What may go wrong and what to do If this…then do this Include rationale What has/ has not worked before (e.g. responds to nasal suctioning) Code status/family situations Difficult family or psychosocial situations Code status, especially recent changes or family discussions
Practice a sign out
Essential Elements for Receiver Readback/Summation: co-orientation Questions/clarifications Collaborative cross check
Other Essential Elements Proper Environment: sterile cockpit No distractions Quiet place Always face to face Start with sickest patient Never say “ This is not my patient….I am just covering for the night”
PGY- 1 Essential Elements of Sign-out Giver Mastery Patient identification Patient background Current conditions or current physical exam Contingency plans Overall general treatment plan
PGY-2 3 Essential Elements for Sign-out Receiver Mastery Readback/summation: Co-orientation Questions/clarifications Solicit other overnight tasks for patient
PGY-3 Has mastered giving and receiving sign-out Working towards: Collaborative cross check Off topic discussion that include teaching points
Summary Effective exchange of information is vital during sign-outs Both the giver and receiver have specific roles and responsibilities Hopefully we have given you some tools to make your hand-offs more effective
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