1. Handing Down the Hand-Off

2. What is a Hand- Off? http://www.flickr.com/photos/cavalierhorn/3938109498/

3. Why is it important ? Amanda Cegielski http://www.flickr.com/photos/thatpicturetakr/3148936883/

4. VariableOdds Ratio for Preventable Adverse Events Cross-Covering Physician6.1 APACHE II Score1.2 History of GI Bleeding4.7 Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Annals of Internal Medicine. 1994;121(11):866-872.

5. Arielle Fragassi http://www.flickr.com/photos/toastytreat/4555895229/ 1)Frank G, Lawler L, Jackson A, Steinberg T, Lawless S. Resident miscommunication: Accuracy of the resident sign-out sheet. J Healthc Qual. 2005;27(2). 2)Arora V, Kao J, Lovinger D, Seiden SC, Meltzer D. Medication discrepancies in resident sign-outs and their potential to harm. Journal of general internal medicine. 2007;22(12):1751-1755. 3)Aylward M, Rogers T, Duane P, Inaccuracy in Patient Handoffs: Discrepancies between Resident-Generated Reports and the Medical Record, Minn. Med. 2011; 94(12) 38-41. 1 1 3 2

6. Photo by: Michael Aylward 1)Kitch BT, Cooper JB, Zapol WM, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Joint Commission journal on quality and patient safety / Joint Commission Resources. 2008;34(10):563- 570. 2)Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Archives of Internal Medicine. 2006;166(11):1173-1177. 1 2

7. A Tao of the Hand-Off

8. Environment Photo by: Michael Aylward

9. ANTICIPATE SBAR AIDET ASHICE DeMIST GRRRR HANDOFFS I PASS THE BATON just go NUTS SBAR MIST PACE PEDIATRIC SHARED SHARQ SIGNOUT SOAP STICC 5P 4P Content

10. Triage Tell the Story Details on Demand Contingency Plans and Concerns Problem Statement: name, age, sex, significant past medical history, main reason for admissions, highlights/important changes since admission. Prioritize the patients: RS=Really Sick S=Sick NS=Not Sick Problems prioritized, relevant information given within context of person taking the hand-off. Hand-off should be interactive, with questioning from accepting physician, two-way communication.

11. [ If...Then ]

12. Rupert Ganzer http://www.flickr.com/photos/loop_oh/3294984769

13. Diagram adapted from Baker DP, Salas E, King H, Battles J, Barach P. The role of teamwork in the professional education of physicians: current status and assessment recommendations. Joint Commission journal on quality and patient safety / Joint Commission Resources. 2005;31(4):185-202

15. Graphics by Michael Aylward

18. Referenc es All images used under Creative Commons license.