1. Communication and Handoffs Cathryn Caton, MD, MS

2. Goals and Objectives Define clinical handoffs Demonstrate the importance of effective handoffs Understand key components of an effective standardized handoff Discuss the handoff environment and communication techniques

3. Clinical handoff A clinical handoff is the temporary transfer of care and responsibility from the primary physician to the covering physician Verbal Written Increased handoffs with reduced work hours Many training programs do not have standardized handoff training programs 75 handoffs/month /team here at MUSC Improving handoffs is a national patient safety goal

4. Handoffs and patient safety Associated with adverse clinical outcomes Sentinel events commonly results from communication breakdown – 65 % of the time 92% of communication errors occur during verbal communication between 1 transmitter and 1 receiver Errors surround omission of content or lack of direct discussion

5. Fellow Resident/Intern Student Attending Fellow Resident/Intern Student Primary TeamConsult TeamTransferring team

6. Ideal handoff components Face to face interaction for verbal communication Updated written or computerized information (use actual dates) Clarity about the patient’s current condition, including severity of illness Anticipating changes in patient condition with specific interventions Minimal interruptions Structured format (time, place)

7. Summary of Themes from “White Papers” Need for training Ensure adequate time for handoff Reduce interruptions Keep information updated in template or technology solution Facilitate interactive questioning Focus on ill patients Delineate actions to be taken

8. Verbal Signout

9. Written sign out

10. Key Messages Good handoffs may reduce sentinel events / improve patient safety Use standardized formats Interactive Focuses on ill patients Provides anticipatory guidance

11. References Joint Commission Sentinel Event Database Greenberg CC. J Am Coll Surg 2007; 204;533 Arora V. Qual Saf Health Care 2005; 14:401 Arora VM. J Hosp Med 2009; 4:433