A Quality Improvement Project on Resident Hand-Offs Using Structured Templates

Objective: To better understand the hand-off process between house staff members on inpatient Neurology services and to improve the quality of written hand-off lists.Background: Defective hand-offs can lead to serious preventable adverse effects. There are very little data on strategies to improve hand-offs within the medical field.Methods: An eleven-points checklist was developed including code status, neurological exam, anticipatory guidance, decisionality, medical history, active problems, future plans, pertinent diagnostic tests, degree of illness, avoiding confusing or vague language. During Phase 0 (Pre-intervention), hand-off lists were collected over 2 months, from three different Neurology services and evaluated using the above checklist. A resident survey was also collected to assess the usefulness of the pre-existing hand-off system. During Phase I, a template for each service was created and utilized over a period of another 2 months and evaluated in the similar manner. During Phase II, templates were modified using residents9 suggestions and implemented for 2 months. A total of 312 patient hand-offs were reviewed, of which 134, 88 and 92 were in Phase 0, I and II respectively.Results: All 11 essential components were included in 5 (4[percnt]), 35 (40[percnt]), and 54 (63[percnt]) of patient hand-offs during Phase 0, I and II respectively (pu003c0.0001). Average resident survey scores indicating the amount of time required to update hand-offs were 3.9, 4.4, and 5.6 (p=0.14) during phase 0, I and II respectively; usefulness during cross coverage overnight were 3.2, 4, and 5 (p=0.06) respectively whereas those indicating usefulness during emergency situations were 3.1, 4.4, and 5 (p=0.04) respectively.Conclusion: This prospective process improvement project demonstrates a significant improvement in the completeness of patient hand-offs using structured templates. Although statistically significant differences in perceived usefulness were only seen for emergencies, the trend for a rise in perceived utility was seen in all three domains. Disclosure: Dr. Lavingia has nothing to disclose. Dr. Book has received personal compensation for activities with AGA industrial device trial as a consultant. Dr. Carlson has nothing to disclose.