In the inpatient setting, rising patient volume and acuity, coupled with duty 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 sign out list within our electronic medical record and specific templates to help populate these lists with the following patient information:
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 Epilepsy program’s handoffs:
Morning sign-out occurs at ~ 0800 each weekday. All of the previous week treating epilepsy team including residents, fellows, and faculty gather with the team coming on service each Monday morning to review the EEG list to ensure adequate hand-off. This may also be done via e-mail if certain team members are not available to meet in person, in which case the on-call fellow or faculty sends a comprehensive e-mail via secure hospital e-mail to all of the relevant parties. Similarly, the hand-off for fellow on call involves an in-person hand-off at 4pm the night they are assuming call and again at 8am when handing off patients to the oncoming team.
Training and Assessment
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.