1. BONNIE C. DESSELLE, MD PROGRAM DIRECTOR LSUHSC PEDIATRIC RESIDENCY PROGRAM Strategies and Tools to Enhance Communication Among Health Care Providers

2. Communication Series Part 1: Hand – offs Part 2: Formal Presentations Part 3: Communication during Emergencies

3. Hand - Offs Mechanism of transferring information, responsibility and/or authority from one set of care-givers to another

4. Sentinel Events

5. Root Causes of Sentinel Events (1995-2005) -The Joint Commission of Accreditation of Hospitals

6. Call to Improve Handoffs Joint Commission, 2006  National Patient Safety Goal World Health Organization, 2006  Prevention of handover errors part of “High Fives” patient safety solutions Institute of Medicine, 2008  Teaching programs “should train residents in how to hand over their patients using effective communication.” ACGME, 2010  Programs must ensure and monitor effective, structured hand-over processes  Must ensure that residents are competent in the hand-over process

7. Group Discussion Characteristics of Worst and Best Sign-offs

8. Group Discussion Live demonstrations of sign-offs

9. Essential Elements for Pediatric Sign-out List Demographics  Name  MRN  Unit/room number  Age  Weight  Gender  Allergies  Admit date Attending physician/Service/Consults  Phone numbers and covering physician History and Problem List  Primary diagnosis(es)  Chronic problems (pertinent to this admission/shift) Current condition/status

10. Essential Elements for Pediatric Sign-out List System based  Pertinent Medications and Treatments  Oral and IV medications  IV fluids  Blood products  Oxygen  Respiratory therapy interventions Pertinent lab data To do list  Check x-ray, labs, wean treatments  Include rationale

11. Essential Elements for Pediatric Sign-out List Contingency Planning  What may go wrong and what to do  If this…then do this  Include rationale  What has/ has not worked before (e.g. responds to nasal suctioning) Code status/family situations  Difficult family or psychosocial situations  Code status, especially recent changes or family discussions

12. Practice a sign out

13. Essential Elements for Receiver Readback/Summation: co-orientation Questions/clarifications Collaborative cross check

14. Other Essential Elements Proper Environment: sterile cockpit  No distractions  Quiet place  Always face to face Start with sickest patient Never say “ This is not my patient….I am just covering for the night”

15. PGY- 1 Essential Elements of Sign-out Giver Mastery  Patient identification  Patient background  Current conditions or current physical exam  Contingency plans  Overall general treatment plan

16. PGY-2 3 Essential Elements for Sign-out Receiver Mastery  Readback/summation: Co-orientation  Questions/clarifications  Solicit other overnight tasks for patient

17. PGY-3 Has mastered giving and receiving sign-out Working towards:  Collaborative cross check Off topic discussion that include teaching points

18. Summary Effective exchange of information is vital during sign-outs Both the giver and receiver have specific roles and responsibilities Hopefully we have given you some tools to make your hand-offs more effective

20. Click to Show Funny Video