1. Handoffs and Transitions of Care Department of Pathology and Laboratory Medicine Deborah A. Sesok-Pizzini, M.D., M.B.A. Carolyn Cambor, M.D.

2. The Goal Safe and Effective Sign-out The Goal Safe and Effective Sign-out

3. Objectives Describe Development and Standardization of Policies for Handoffs and Transitions Define Transitions of Care Define Resident Schedule for coverage Define Level of Responsibility and Expectations for Handoffs

4. Residency Program Policies for Handoffs and Transitions Clinical Pathology Autopsy Pathology Surgical Pathology Cytopathology

5. Document Control Hospital of the University of Pennsylvania Department of Pathology and Laboratory Medicine Division of Laboratory Medicine Section : Residency Program Policies Handoffs and Transitions Version: 1 Effective date: 8/24/2012 Title: Clinical Pathology on Call and Transitions of Care

6. Clinical Pathology Handoffs

7. Schedule and Coverage Define hours per shift coverage (within ACGME guidelines) Define start and stop time of coverage Define responsibility of coverage (PGY1- PGY4) Define responsibility of handoffs – Who contacts who, how, and where – Required handoffs

8. Resident Coverage- Transitions of Care Define Time of transfer of care Clinical Pathology – 5 PM and 9:30 PM – 5 PM daytime resident will contact the PGY1 call resident only if patient care issues need to be handed off – Care complete when resident verbally or electronically acknowledges the information

9. Resident Coverage Transition of Care – 9:30 PM upper level residents contacts the PGY1 to receive information about ongoing patient issues. – Care complete when resident verbally or electronically acknowledges the information – Why support 2 different handoffs? Creates learning opportunities for PGY1 residents Allows opportunities for teaching and mentoring from more senior residents and continuity of overnight coverage

10. Additional Handoff Mechanisms Calls during the day are posted as documents on the secure Pathology Pulse webpage Calls during the evening are also posted Call summaries are faxed to the attending on the CP service for their review and follow-up the next day Morning Report Conference for one hour every Mon and Fri, handoffs to residents covering services

11. Assessment of Handoffs Plan to perform assessment using the HUP assessment tool available at http://uphsnet- test.uphs.upenn.edu/ResidentPortfolio/Hom e/Login Senior residents and attendings involved in the assessment process Gave feedback about the need for a N/A selection

12. “The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw quotes