In the inpatient setting, rising patient volume and acuity, coupled with work hour restrictions, has required an increase in the number of transitions of patient care from one physician to another (handoffs). It is therefore of paramount importance that handoffs be conducted in a high quality manner.
Whenever feasible, handoff communications should be face-to-face, in a relatively quiet setting, with simultaneous availability of Health Link and PACS. In simple cases (e.g., the night float resident is assuming care for a stable epilepsy monitoring unit patient with whom he’s already familiar), asynchronous communication via secure messaging or the sign-out list is permissible.
In order to promote high-quality handoffs, we use a standardized patient signout list within our electronic medical record and specific templates to help populate these lists with the following patient information:
I: Identify the patient, service, and attending physician
D: Diagnosis and current condition
E: Events that have recently occurred
A: Anticipated changes in condition or treatment—what to watch out for
L: Leave time for questions and discussion
Following is a summary of the Clinical Neurophysiology Fellowship program’s handoffs:
Morning sign-out occurs at ~ 0800 each weekday. All of the previous weeks’ treating epilepsy team including residents, fellows, and faculty gather with the team coming on service each Monday morning to review the
Training and Assessment
The above handoff processes and our program’s emphasis on interprofessional teamwork are introduced in our orientation sessions each July. During the year, we hold additional conferences with our interdisciplinary colleagues to learn about their roles in more detail and to facilitate team building and communication. Further, interprofessional communication is an important aspect of clinical case reviews with neuropsychology, nursing, technicians, and pharmacists.
Assessment and feedback regarding fellows’ handoff and communication skills occurs via a variety of methods:
- Epilepsy faculty directly receive the fellows’ handoff several times a week and observe the fellow-to-fellow handoffs and are able to incorporate these findings into fellow’s rotation evaluation.
- There is peer-to-peer evaluation of fellow-to-fellow and fellow to resident handoffs via electronic peer evaluations.