1. WELCOME

2. Case presentation 12am1am2am3am4am5am6am7am8am      Dyspnea CXR Admit Floor ED MD ED MD2 AMO RN-- MD Night float MD MAT MD

3. Day 1 10am2pm6pm10pm2am6am10am2pm6pm     Decom- pensates ICU Stable ICU fellow ICU MD Overnight ICU fellow MD ICU MD

4. Day 2 10am2pm6pm10pm2am7am10am2pm6pm      Intubated ICU Extubated Transfer to the floor ICU MD Overnight ICU fellow AMO OAT MD

5. First 48 hrs Total providers in charge of the care: 10 Total Handoffs: 13

6. 15 handoffs per patient for a 5 day stay 300 handoffs per month for each intern >8,000 training programms >100,000 trainees >6 million patients UCSFNationally UCSF Medical center: 4000 handoffs daily, 1.5 million handoffs a year Vidyarthi AR, Arora V, Schnipper JL, Wall SD, Wachter RM. Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. Jul 2006;1(4):257-266.

7. Sentinel event statistics www.jcaho.org

8. HANDOFF STRATEGIES: LEARNING TO COMMUNICATE EFFECTIVELY Sumanta Chaudhuri Saini, MD Kartik Reddy, MD Vipulkumar Rana, MD Gopichand Naguboyina, MD Medical College of Wisconsin

9. Learning Objectives (1) Recognize the components of a complete handoff, including official ACGME guidelines (2) Know which components of a handoff to communicate in your verbal sign-out (3) Learn to communicate important information for patient care efficiently and quickly (4) Be able to determine what constitutes excess information (5) Recognize the limitations and advantages of a handoff based in the electronic medical record

10. The Components of a Complete Handoff

11. 2006 Joint commission national patient goal (NPSG)2E Interactive communications Up-to-date and accurate information Limited interruptions A process for verification An opportunity to review any relevant historical data JCAHO 2008, p12

12. ACGME guidelines Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Programs must design clinical assignments to minimize the number of transitions in patient care. Institutions and programs must ensure and monitor effective, structured handover processes to facilitate both continuity of care and patient safety.

13. ACGME guidelines cont… Programs must ensure that residents are competent in communication with team members in the handover process. Institutions must assure the availability of schedules that inform (patients and) all members of the health care team of faculty and residents currently responsible for patient care. Residents and attendings should inform patients of their role in the patient’s care.

14. The Verbal Sign-Out

15. Quick and Efficient Communication

16. What constitutes “TMI”?

17. The EMR based handoff: advantages and limitations

18. Thank You…