1. Tip of the Day

2. Effective team leaders encourage open communication, and help organize and prioritize information transfer in the handoff. Be willing to take the lead!

3. Cross-monitoring provides a safety net within your team by actively recognizing and addressing errors. You watch my back, and I'll watch yours!

4. Feedback should be given and received by all team members
Feedback should be given and received by all team members. It should be timely, respectful, specific, considerate, and directed towards improvement. Give the kind of feedback you'd like to receive.

5. Briefs are great for short-term planning to review roles, responsibilities, and available resources. They may be "brief" but they're worth the time!

6. Debriefs are essential after significant events
Debriefs are essential after significant events. By taking the time to review roles, responsibilities, and resources we can improve patient outcomes and reduce errors. Think of them as an opportunity to celebrate successes and learn from mistakes.

7. Huddles provide opportunities to briefly touch base about critical issues and emerging events. This is an ideal time to express concerns, anticipate outcomes, and help everyone identify contingency plans. Think of them as "work-in-progress" sessions!

8. Assertive statements are important
Assertive statements are important. They should communicate concerns and suggestions while respecting and supporting authority. They are especially important to avert errors in patient care. Use them!

9. Ineffective communication is a root cause of nearly two thirds of all sentinel events reported. Don't let it happen to you!

10. With a shared mental model, team members are “on the same page
With a shared mental model, team members are “on the same page.” Are you thinking what I'm thinking? Great!

11. Cross-monitoring - it's how team members monitor each other’s task execution and give feedback. If you practice good cross-monitoring, someone’s always got your back.

12. We all have different learning styles, training, knowledge of patients, and experience. Checking in with your receiver helps ensure the handoff will be smooth and successful. How we learn affects how we handoff!

13. Be aware of the power of interruptions
Be aware of the power of interruptions. They may result in errors or omissions, but may also provide new or updated information and an opportunity to reframe the shared mental model. It's important to set ground rules for when interruptions are allowed. You may need to stop talking while I'm interrupting!

14. Printed handoff documents provide a foundation for the verbal handoff; they are not a substitute. You also need to know what's "between the lines."

15. Printed handoff documents should follow the I-PASS format for verbal handoffs, but also include supplemental information. They will serve as the reference document after the verbal handoff is complete. Some things may go "unsaid," but the printed document should fill the gaps!

16. Printed handoff documents allow the receiver to follow along
Printed handoff documents allow the receiver to follow along. Visual learners may like to read along while listening to the handoff, while verbal learners may prefer to hear it read aloud. Be aware of how your receiver is processing the information. Know thyself, and thy receiver!

17. Printed handoff documents require at least daily updates, and should be reviewed before each handoff. They should be succinct, accurate, and high-quality. Take pride in your work!

18. The senior or supervising resident is responsible for editing and ensuring the quality of the printed handoff, but everyone is responsible for reviewing it for accuracy. Always remember - patient care is a team sport!

19. Establish WHEN and HOW OFTEN and by WHOM the written tool will be updated. The written tool is best utilized by incorporating time for reviewing and updating into your work flow – make it part of your daily routine!

20. Printed handoff documents should not be a running summary of the hospitalization - only include information that is both current and relevant. Delete old, inaccurate, or irrelevant information. Remember - copy-and-paste is easy, but it's also error-prone.

21. "This is a sick patient!" Remember - when handing patients off, identify the sickest and most worrisome patients on the team. Don't make others figure it out on their own!

22. "Watchers" are the patients at highest risk of deteriorating
"Watchers" are the patients at highest risk of deteriorating. Identify them, and keep a close eye on them!

23. Patient summaries cover the "big 5" essential elements: summary statement (one-liner), events leading up to admission, hospital course, ongoing assessments (by problem/diagnoses), and plans (by problem/diagnoses).

24. Events leading up to admission should include a chronological, bulleted list of essential exam/lab findings. The list can be truncated when a high degree of diagnostic certainty is achieved.

25. The description of hospital course should provide diagnostic reasoning, highlight special considerations, and offer a differential diagnosis and assessment.

26. Assessments should take the raw data and convert it into a medical problem (not an organ system!). Put the pieces together so I can see what you see!

27. Effective patient summaries are succinct, concise, and facilitate the receiving resident’s understanding of the patient. They include medical language, especially semantic qualifiers (dull vs. sharp, mono vs. poly, etc.). Choose your words carefully - brevity is important but accuracy is essential!

28. The patient summary is like a garden – it requires daily care and “pruning!”

29. “Bullets are best” when it comes to creating a patient summary!

30. The plan in the patient summary should contain a global plan of care for the patient’s hospital stay, and NOT a “to do” list for the covering residents. “To do” items should be included in the action list.

31. The action list includes specific "to do" items with a clear indication of timeline, level of priority, clearly-assigned responsibility, and indication of completion. Tell me what I need to do - I'm not good at telepathy!

32. If no action items are anticipated, the giver of handoff should clearly specify that there is “nothing to do.” Don't worry about being bored - something will come up!

33. Situation awareness is “knowing what is going on around you
Situation awareness is “knowing what is going on around you.” This includes your patients and your teammates. The more aware you are, the more prepared you are!

34. Contingency planning offers an opportunity for problem solving before things go wrong. Remember Murphy's Law and BE PREPARED!

35. Contingency planning ensures that the receiving team is prepared to anticipate a change in patient status and respond to potential events. Remember that the receiver may not have been paying attention on rounds!

36. Invite clarifying questions and use check-back to ensure that the receiver understands the contingency plans. Some receivers are shy, so if you learned something new, share it!

37. Contingency planning: Are you prepared for the worst. Great
Contingency planning: Are you prepared for the worst? Great! Now make sure your teammates are as well.

38. “Anything that can go wrong, will go wrong
“Anything that can go wrong, will go wrong.” Be prepared with a good contingency plan.

39. Synthesis by receiver promotes a shared mental model by providing a brief re-statement of essential information. It lets you know that your message was heard!

40. Synthesis by receiver is an opportunity for the receiver to have an active role by clarifying elements of the handoff, asking questions, and ensuring that there is a clear understanding. You can leave knowing your patient will be in good hands!

41. Synthesis by receiver must be brief and not a restatement of the entire handoff. Include just enough to show that your heard and understand the information!