1. Patient handoff simulation: Does formal training build skills and confidence in transitions of patient care? Daniel Relles, Renee Tholey, Christine Feldmeier, Richard Burkhart, Stacey Milan Thomas Jefferson University, Philadelphia, PA April 24, 2013

2. Overview Introduction Methods Simulation Assessment Training Results Conclusion

3. Overview Introduction Methods Simulation Assessment Training Results Conclusion

4. Introduction Medical Errors: Communication Transitions in care Signout process >2x daily Content vs Process Formal training and education focus on content No training on process, efficiency, or self- management

5. 9 - 5 Terminology Signout/Handoff Can new interns be taught systems and strategies to prioritize and recall important patient updates? “Running the List”RTL Nightfloat 6 - 6

6. Overview Introduction Methods Simulation Assessment Training Results Conclusion

7. Overview Introduction Methods Simulation Assessment Training Results Conclusion

8. March 2012 2627 Course Begin 28 SimMan 29123 45678 SimMan 910 111213 SimMan 1415 SimMan 1617 181920 SimMan 21222324 12 3 12 12 SimulationAssessment 3 Training

9. Team Handoff Simulation End-of day, team “running the list” Roles 6 - 8 Interns (MS4) 1 Junior resident (faculty) 1 Senior resident (faculty) Agenda Activity overview (5 min) Review of patients (5 min) “Run the list” (30 min)

10. Team Handoff Simulation Task 1 complex patient 1 basic patient “You are the intern, who will sign out to night float after we run the list.”

11. Materials Service List Complex H&P Basic H&P

12. Materials: Service List

13. Materials: H&P

14. Materials Service List Complex H&P Basic H&P

15. Overview Introduction Methods Simulation Assessment Training Results Conclusion

16. Assessment: Urgent Issues

18. Assessment: Routine Issues

19. Overview Introduction Methods Simulation Assessment Training Results Conclusion

20. Training SimMan simulations Formal training

21. Formal Training ~45 minutes Best practices from PGY1 & PGY2 “What’s your system?” Techniques and strategies for patient management Help support efficiency, recall and prioritization

22. Formal Training Coloring systems (black = run the list in black, blue = update the list, red = issues to escalate) Cross-out/check box/circle Circle, squares, and underlines Imaging: 3 boxes (ordered/completed/read) Separate list: top priorities Document every nursing page Consistent spaces Reduced printing Create table; generate list of “things to do” per pt Strategic folding

23. Formal Training

28. Overview Introduction Methods Simulation Assessment Training Results Conclusion

29. Identification of Urgent Issues n=21, p<0.05

30. Identification of Routine Issues n=21, p<0.05

31. Overview Introduction Methods Simulation Assessment Training Results Conclusion

32. Described a simulation of a team signout and patient handoff that is a useful adjunct to on-the-job training Improved ability to identify and recall urgent and non- urgent service issues Helped build confidence in recall and prioritization

33. Contact: daniel.relles@jeffersonhospital.org